BONE MARROW EXPERT: INSURANCE MAY NOT COVER `EXPERIMENTAL' COSTS

CAPE GIRARDEAU -- People seeking health insurance to cover life-threatening conditions like cancer should note whether an insurance policy uses the words "experimental" or "bone marrow," says a cancer specialist.

If those words are used, the policy may not cover a newer, high-dose chemotherapy treatment that has an improved survival rate over conventional therapy, said the specialist, Dr. Gary Spitzer.

Spitzer, director of the Division of Medical Oncology and Bone Marrow Transporation at St. Louis University Medical Center's School of Medicine, presented a physician education program Wednesday at St. Francis Medical Center. The program was a joint tumor conference attended by representatives from both St. Francis and Southeast Missouri Hospital.

Spitzer said the newer treatment, in which a person's bone marrow is frozen after removal and later transplanted to keep the chemotherapy from damaging it, is being used for a number of maladies. Leukemia, Hodgkin's Disease, and breast cancer are examples. The treatment is also beginning to be used for ovarian cancer.

"So this is becoming an increasingly applied therapy and I think it's associated with an increased (rate) of cure," said Spitzer.

The treatment involves a 10- to 20-fold increase in dose and operates on the premise that the cancer cells are not sensitive enough to be killed by the lower dose of conventional chemotherapy.

Use of the therapy has increased greatly over the last five years, said Spitzer. But the therapy can cost twice as much as the conventional treatment. On average, Spitzer said, the cost is over $100,000, and it's a fee insurance companies in this country are not anxious to pay.

"A lot of insurance carriers don't cover it, and they try to make it (out) as experimental. And I still don't know what that definition is."

Probably only 30 percent of insurance carriers cover the procedure, Spitzer estimated, whereas he said he believes all carriers cover conventional cancer therapy. Of those 30 percent, some carriers cover 80 percent of the cost and some cover 100 percent, he said.

Spitzer said insurance carriers are forcing each other into covering the costs of the therapy. Because the therapy requires a permanent and expert team of physicians, nurses, and treatment staff members, the carriers are fearful of it. They are concerned the treatment is being offered by community hospitals solely for economic gain, he said.

Eventually, Spitzer said, insurance carriers will have to break down and begin paying for the newer therapy. More data, legal suits, and action on the part of women, he said, will be required first though.

Women need to start an education process and take control because use of the treatment in breast cancer will affect more patients, he said.

Spitzer encouraged the public to get more information through oncologists. The oncologists in Cape Girardeau, he said, are a very sophisticated group who are aware of the latest therapy and willing to let their patients go elsewhere for additional information.

"It's most surprising of a town this size how well they're integrated," he said.