Trial Ordered for Marrow Transplant Suit

A San Diego Superior Court judge has ordered a jury trial in a case in which a woman sued health insurer Health Net for twice refusing to pay for a bone marrow transplant to treat her breast cancer.

The Woodland Hills-based health maintenance organization eventually agreed to pay for a transplant for Viviana Vander Stoep of San Diego after it lost a jury trial involving another patient who was also denied a transplant to treat breast cancer.

In both cases, the company contended that the procedure was investigational and therefore not eligible for reimbursement.

Despite the agreement to reimburse Vander Stoep after she had two transplant operations, her suit contends that Health Net’s prior refusals constituted a breach of contract and that Vander Stoep suffered emotional distress from those actions, said her attorney, Mark Hiepler of Oxnard.

Hiepler represented the family of Nelene Fox (his sister), which won a Riverside County jury verdict ordering Health Net to pay a record $89-million fine for denying a bone marrow transplant to Fox, who later died from breast cancer. That verdict was the largest U.S. plaintiff’s verdict ever involving the denial of medical benefits.

Health Net reached an out-of-court settlement with the Fox family in April for a lesser, undisclosed sum.

Health Net officials said the decision to reimburse Vander Stoep did not alter the company’s policy of rejecting bone marrow transplant treatment for patients with late-stage breast cancer.

The HMO plans to appeal the San Diego judge’s ruling, said Don Prial, a company spokesman. The HMO contends that Vander Stoep’s membership contract stipulates that the dispute should be resolved through third-party arbitration, not in court.

Hiepler said Vander Stoep, a former teacher, has recovered from her November transplant and is in good health.