After months of scuffling with her insurance provider, senior agricultural and resource economics (ARE) graduate student Isabel Call can finally receive life-saving treatment for a rare cancer condition.
Since May, Call has been appealing to Anthem Blue Cross to cover the $160,000 treatment that she could not have afforded otherwise. Call is covered under the UC Student Health Insurance Plan (UCSHIP), which is provided by a contract with Anthem and guaranteed for all graduate and undergraduate students in the system.
Call is due to receive the treatment today at the MD Anderson Cancer Center at the University of Texas in Houston.
“Since I decided to go through with the treatment, every day I thought to myself ‘I’m going to Houston any day now,’” Call said. “I was ready to buy that next-day flight.”
Call’s condition is classified as a neoplasm carotid body tumor, a rare cancer which affects her neck and neighboring areas. The bulk of her tumor was surgically removed last March at MD Anderson, but the fragments left in her neck are considered malignant.
Dr. Adam Garden, Call’s radiation oncologist in Houston, recommended a state-of-the-art procedure known as proton beam radiation therapy (PBRT) first developed in the 1990s.
Unlike more conventional radiation therapy, PBRT utilizes controlled proton beams to deliver high doses of radiation while minimizing lifelong side effects including permanent neck stiffness, loss of salivary glands and the formation of secondary cancers.
Garden estimated that PBRT would cost Call $160,000, while conventional alternatives would range from $50,000 to $100,000. Without insurance coverage, Call would not be able to pay the full amount of either option.
“They told me I would get a 35 percent discount if I paid up front,” Call said. “I don’t think any student can afford to pay even 65 percent of $160,000.”
Despite an appeal composed by Garden on the necessity of the treatment, Anthem continued to deny coverage on the grounds that PBRT remains an “investigational” treatment for the head and neck and that there is insufficient clinical data on its effectiveness.
“What they didn’t consider is that anything is investigational for my condition, which is just so rare,” Call said.
Call and her supporters remain suspicious of Anthem’s initial rejections because the review process was not very transparent.
“My doctors, I believe, are the best in the field,” Call said. “On the other hand, we don’t exactly know who Anthem consulted for their decision.”
According to Heather Pineda, Director of UCSHIP at the UC Office of the President, Anthem utilizes “licensed clinical experts” to review medical conditions for coverage.
“I personally worked with Anthem on Ms. Call’s request for benefits to promote additional review of her situation, and I am very pleased a solution was reached in her case,” Pineda said.
With the encouragement of her doctors and the support of her peers, Call decided to fight the decision a few days shortly after. A second appeal entailed a complete and rigorous assessment of the treatment accomplished by Call and other ARE graduate students.
“We really approached it like a collaborative research project,” Call said. “We began by looking up articles, finding the key points and then we continued to work on it over e-mail.”
The second appeal was successful in convincing the review board at Anthem to reverse its initial decision.
Another crucial component of this reversal was pressure put on the university by a network of supporters.
“Faculty and staff have institutional support from the university in these cases,” said Emilia Tjernstrom, a junior ARE graduate student and organizer of the online petition for Call’s cause. “Graduate students do not have access to this which is why rallying support was important.”
Over the course of Memorial Day weekend, the petition collected more than 1,500 signatures. This number peaked at 6,000 by the time Call received the coverage. A planned rally for June 4 was canceled after the movement’s goals were met.
“This is a story that is easy to relate to and the right thing to do is clear,” Tjernstrom said.
The Graduate Student Association (GSA) and members of the Agricultural and Resource Economics Department also expressed official support for Call’s case.
“We hope that this case will also encourage both Anthem and the UC to review their policies on advanced, life-saving care for unusual conditions,” said Colin Murphy, GSA External Chair. “We hope no one in the future will be forced down the same path.”
UCSHIP was launched in 2010. This year, undergraduates and graduates across all UC campuses joined the plan. Benefits like worldwide coverage and a $400,000 maximum lifetime plan make UCSHIP an attractive option for many students, but the plan can fall through the cracks in special cases like Call’s.
“There are a lot of good things to say about the student health insurance plan,” Call said. “It is why I was able to go to one of the country’s best cancer centers.”
For some, there is a serious incentive problem with the insurance plan.
“UCSHIP covers chemotherapy and radiation therapy for treatment of cancer at 90% of negotiated rates for Anthem network providers, and students are responsible for 10% coinsurance,” Pineda said.
While Call will now be receiving the treatment she needs, the manner of management in special cases reveals how UCSHIP could fall short for some students, especially those with unique conditions like Call’s.
“It is pure luck,” Call said about her condition. “It could have been anyone.”
JUSTIN ABRAHAM can be reached at firstname.lastname@example.org.
EDITOR’S NOTE: The original article incorrectly stated that UCSHIP was established in 2001 for undergraduates and then in 2009 for graduate students. These dates are when the UC Regents voted on health insurance matters for students, not when the plan was formally in place. The original article also stated: “Coverage for expensive treatments must receive explicit approval from the Chief Risk Officer at the UC Office of the President because of the UC’s direct financial stake in the procedure.” This sentence was incorrect. The Aggie regrets these errors.