Cancer patient gets needed treatment

CHESAPEAKE,Va - Debbie Derleth called 10 On Your Side as a last resort when her insurance company refused to pay for breast cancer treatments her doctor prescribed.

Debbie says Ten On Your Side may have saved her life.

Blue Cross Blue Shield's Federal Employees Program paid for Debbie's surgery, chemotherapy and radiation when she was diagnosed with breast cancer. The problem, the drug Herceptin, which is sometimes prescribed to help prevent recurring cancer, costs $5,000 a dose.

Debbie had seven of 17 treatments when Blue Cross Blue Shield denied payment.

The company sent her doctor a letter which explained that Debbie's tumor didn't meet their criteria for that particular medication. Her tumor was only eight millimeters, which is under their 10 millimeters guideline.

Oncologist Dr. James Stark tried to explain size wasn't the issue. His decision was based on genetic tests.

"As her doctor, I have to play the hand I'm dealt and I'm dealt a lady with a small tumor and many adverse features, so I decided the best thing to do for her would be to give her this extra drug."

Blue Cross wouldn't even listen to his reasons until 10 On Your Side called.

After our first story aired, the company agreed to reevaluate and three weeks later Debbie got another letter stating the insurance company's doctors had talked to Dr. Stark, reviewed new research and basically changed their mind.

Debbie's tears of anger and fear turned to tears of joy. "I was beginning to give up hope, so it came just in time, on my husband's Birthday, and just in time for Thanksgiving."

Blue Cross now says it will pay the $35,000 for the first seven treatments and for the 10 more treatments prescribed.