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Cancer patient sues HMO to cover chemotherapy drug


Al Musella's Comments: (This is his personal views and are not necessarily the views of the Musella Foundation!)



Website: http://www.miami.com/mld/miamiherald/business/4776086.htm?template=contentModules/printstory.jsp

Posted on: 12/19/2002

Posted on Thu, Dec. 19, 2002

Cancer patient sues HMO to cover chemotherapy drug

JILL BARTON
Associated Press

WEST PALM BEACH, Fla. - A woman with brain cancer sued her HMO Thursday for refusing to cover a chemotherapy drug prescribed by her doctor.

Shelley Otis' doctor prescribed the drug after she had surgery to remove a brain tumor. But she said her insurance company, Well Care HMO Inc., has refused to pay for it. The drug costs about $9,000 a month.

Otis, 35, and her husband, Mike, said they took out a second-mortgage on their home and borrowed as much money as they can to pay for the medication. The lawsuit, filed in Palm Beach County Circuit Court, is seeking unspecified damages and an injunction that would require Well Care to cover the drug.

Jeff Tucker, a spokesman for the Tampa-based Well Care, said Thursday the company has tried to help Otis. Tucker said Otis took out a plan in September 2001 that had no drug benefits attached to it. He said a case worker tried to help Otis obtain the drug at cheaper prices from the manufacturer and from another agency, but both said Otis was too affluent.

"They have gone out of their way trying to get her some help," Tucker said. "It's an unfortunate situation."

Otis, a mother of four boys ages 4 to 14, discovered she had brain cancer in July.

Her oncologist, Dr. Armando Armas, prescribed her to take an oral chemotherapy drug, called Temodar. Traditional chemotherapy medications are taken intravenously. Armas documented that no other form of chemotherapy could be substituted for Temodar, according to a letter he sent to Well Care.

Well Care classifies the drug as a pharmaceutical drug, which is not covered under Otis' plan, according to the suit. Otis said when she signed on with the HMO, the drugs were covered but the plan stopped covering them about a year ago. She said her premiums have only increased.

Otis said she filed the suit because she wanted to provide some relief for herself and others.

"I'm on a little bit of a time frame as far how much time I have," she said. "I just want to do whatever I can in that time."

Otis' attorney, Greg Barnhart, said Well Care is trying to avoid its obligation to provide coverage for his client.

"The HMO is trying to save money, even though the life of this young mother is at stake," he said. "It's a terrible way to treat people."




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