Transplant for Cancer Girl Experimental, Insurer Says
A spokesman for the insurance carrier that has declined to pay for a bone marrow transplant for a stricken 5-year-old says the procedure does not have a “track record” of successfully treating her condition.
The child, Holly Keuthan, suffers from Ewing’s sarcoma, a form of cancer growth in children and adults that attacks multiple organs. Her doctor says her chances of survival are 20% with regular chemotherapy but could be higher if Holly receives the marrow transplant that would allow higher dosages of chemotherapy.
But Robert Nolan, an Aetna Life and Casualty Co. spokesman, said the insurance company has reviewed Holly’s case and will not pay for the treatment because it is experimental and not covered by the family’s health plan.
“We are not in the ‘no’ business,” Nolan said. “But we’re trying to be responsible. We are contracted to pay for treatments that are effective.”
Nolan said that Aetna’s medical directors have not found any evidence supporting contentions that the transplant treatment would counter Ewing’s sarcoma.
Insurance companies are placed in a difficult situation when it comes to new medical technology and treatments, said Dan White, a spokesman for Health Insurance Assn. of America. Without governmental guidelines to determine what is acceptable treatment, insurance companies have to decide for themselves what is experimental, he said.
“This is the most difficult part of the business--deciding what is acceptable treatment or not,” White said. “It can be life or death for many. But it’s not something that is done arbitrarily.”
Dr. Mitchell Cairo, Holly’s physician and director of the bone marrow transplantation division at Children’s Hospital of Orange County, said the new treatment has been used on other Ewing’s sarcoma cases successfully.
“Insurance companies should be encouraging any treatment that gives the best opportunity of being cured,” Cairo said. He added that Holly is responding well to chemotherapy and is “an excellent candidate” for the new transplant treatment.
With the transplant, Holly’s doctors say she can be treated with “aggressive chemotherapy,” higher dosages designed to kill off the cancer cells that have already tainted her blood and reached her lungs.
The Keuthans, of Dana Point, are appealing to Aetna to reconsider their daughter’s case. Although it won’t pay for the new treatment, it will pay Holly’s current medical bill, which so far has come to more than $100,000, the family said.
The $350,000 cost of the bone marrow transplant operation is more than seven times what Jan Keuthan, her father, makes a year, the couple said.
A trust fund has been set up by friends of the family. Contributions can be made to: Trust Fund for Holly, Union Bank, 31971 Camino Capistrano, P.O. Box 637, San Juan Capistrano, Calif. 92675.
