Posted: 23 Aug 2011 06:39 AM PDT
In yesterday's article about stem cell transplants for older multiple myeloma patients, I mentioned in passing how Medicare might have an issue with harvesting first and transplanting later.
My source was a myeloma survivor named Walt, and his wife and caregiver, JaneClare. While speaking with them last week during our local Nature Coast Multiple Myeloma Support Group, JaneClare shared how Medicare was refusing to authorize Walt's stem cell harvest, unless he used the cells withing ten days.
Isn't that a perfect example of how Medicare policies can end-up costing us all money in the end. Forcing someone into a transplant before they are ready is crazy!
During an interview after the meeting, Walt explained how the cost to collect and store his cells at Moffitt Cancer Center could cost as much as $70,000. That's a lot. But according to Cigna Insurance, the total cost of an autologous stem cell transplant--along with pre and post-transplant testing and follow-up averages over $300,000--and that's the adjusted cost after insurance cost controls.
Since the $300,000+ total includes the $70,000 cost to harvest, why not allow a patient to collect and store their stem cells before they are damaged by years of chemotherapy and radiation?
But there is more to this than just the cost. By refusing to let Walt collect and store, his therapy options are limited, forcing his oncologist to adjust the type of anti-myeloma treatments to those which damage stem cells least, just in case Walt decides to transplant in the future.
His stem cells will also be older, beat-up and battered by years of therapy. But I guess Medicare doesn't "care" about that!
I recall being forced to appeal my Blue Cross Insurance Company ruling, refusing to allow me to collect and store my stem cells four years ago. I was successful. But it took a lot of time and emotional energy to complete the appeal. Let's face it--this type of thing is stressful, especially when you aren't feeling well and undergoing chemotherapy.
At the time, my doctor recommended collecting with the intent of getting a transplant immediately. Back then, Blue Cross' rule required transplantation within three months. His suggestion: "Let us harvest your cells. Insurance will pay for it in a month or two. Then I will write a letter, explaining why it was medically necessary to delay your transplant."
Even though my Mayo Clinic doc explained how they were doing it all of the time, I was never comfortable using that option. Fortunately, my insurance company eventually caved--thanks to help from Mayo Clinic's insurance counselors.
But it sounds like insurance companies have wised-up to that option. Think it is a coincidence that Medicare now requires a patient's transplant be completed within ten days?
Walt and JaneClare are appealing. I will keep everyone updated.
Feel good and keep smiling! Pat
Posted: 22 Aug 2011 05:11 AM PDT
I have been writing a lot about stem cell transplants lately, having recently lived through the experience myself.
I hope my older readers haven't felt left out or disinterested. Ten years ago, most transplant units excluded anyone over 70 years old. But recently that number has steadily gone up to 75 or even 80 years old at some locations.
I am constantly reminding older support group members to consider getting their stem cells harvested. Did any of you happen to catch Gavin McStay's Myeloma Beacon article last week on the subject:
Simply click-on the headline link above to access the article. It is worth a look.
This point jumped-out at me:
"Patients below or above 75 years of age showed no difference in mortality at day 100 (2 percent compared to 6 percent)." Overall response also looked similar to those in younger patients.
I'm not pushing the idea of getting a stem cell transplant for anyone. I fought the idea for a long time myself. But I always kept the option open, even while I was trying to avoid the procedure. That's why I had my cells harvested after my initial induction therapy, back in 2007.
Patients in their late 60's and early 70's should consider having their stem cells harvested, before waiting too long, or starting melphalan therapy.
I also understand Medicare is refusing to pay for a harvest only--and to store the cells after they are harvested. I will write a bit more about his tomorrow, along with a medical update on my condition, one month after coming home.
Feel good and keep smiling! Pat
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