Archive for the ‘Affaire du coeur’ Category.

10 years!

Yesterday, my wife and I celebrated our 10 year anniversary. Considering the events that brought us together, I’ve come to recommend marrying strangers. That seemed to work for us. 🙂 Best 10 years of my life!

So to celebrate, and oddly reflecting our marriage ceremony, my wife was sick, and my legs hurt so much I could barely walk, even with the cane.

Ah well…tonight we’re going to 13 Coins. If you’re ever in Seattle, you have got to try this place, and you’ve got to sit at the counter to watch them cook.

Okay, on to my usual nonsense.

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Affaire du coeur, Epilogue

Having opened the can of worms, Regence spent the next year getting it’s butt kicked in the press. The Insurance Commissioner also began using it as a political platform. Here’s a sampling of the articles that were published during that year.

Senn Battles Insurers On Er Coverage — She Faults 4 Major Carriers For Denying Claims Under Law
Tuesday, March 02, 1999 : Business
State Insurance Commissioner Deborah Senn is waging a battle against health-insurance companies that she says illegally deny coverage of emergency-room visits. Senn wants the …

Insurance Carriers Criticized For Suit
Saturday, March 06, 1999 : Local News
What this is really about is, the carriers are angry. And they’re angry because they got caught.” Senn said Tuesday the state’s four largest health-care carriers should have approved …

Regence Blueshield CEO Tops List Of Best-Paid Health-Insurance Execs
Thursday, April 15, 1999 : Business
Deborah Senn’s annual list of executive salaries in the industry. His compensation represents a 20 percent pay raise over his 1997 earnings. Not far behind Dean was Premera Chief …

Nice Work If You Can Get It
Monday, April 19, 1999 : Business
Last week, the state Insurance Commissioner’s Office reported that Regence BlueShield Chief Executive Officer Richard Nelson made $386,003 in 1998, not including bonuses. That’s …

Regence Blueshield To Drop Plan Used By State Workers
Thursday, July 22, 1999 : Business
SEATTLE – Regence BlueShield has decided to stop selling one of its health plans to state employees and retirees. The company says its modified Selections plan has lost $32 million …

2 Big Insurers Stop Selling To Individuals — Group Health, Regence Opt Out
Wednesday, September 01, 1999 : Business
Chris Bruzzo, a spokesman for Regence BlueShield. “It becomes a statewide health-care problem.” Insurers losing money And this is why: In 1993, state lawmakers passed sweeping …

Regence’s Rate Filings May Have Violated Law, Senn Contends
Friday, October 15, 1999 : Business
Senn denied a Regence request to raise rates 28.1 percent for 55,000 people who buy health insurance individually, not through employers. At the time, Regence officials said they would…

Insurer Regence Denies It Manipulated System
Saturday, October 16, 1999 : Business
Regence asked four times for a 28.1 percent increase in rates paid by 55,000 people who buy health insurance individually, not through employers. Senn eventually agreed to a 25.8 percent…

Surgeons Dropping Regence; Patients Are Casualty In Fray With State’s Largest Insurer
Tuesday, December 21, 1999 : Business
Regence BlueShield, the state’s largest health plan. Regence covers about one in five people in Washington. The surgeons canceling contracts say that for certain procedures, they are…
The Insurance Commissioner used the story as a political platform…

Senn touts personal touch in her campaign for Senate
Sunday, August 20, 2000 : Business
Democratic nomination for U.S. Senate, she leads an army of the sick and injured on the campaign trail – living testimony of her self-portrayal as a consumer advocate. There is Victoria …

Candidates aim at Gorton
Monday, September 11, 2000 : Business
Questions in the first televised debate between Democratic Senate candidates Deborah Senn and Maria Cantwell last night may have been about dams, farms and campaign finances, but Sen…

‘Concierge physicians’ medical model growing
Friday, May 28, 2004 : Local News
Seattle doctor, sounds like “something small and fluffy, for rich people.” Whatever it’s called, more and more doctors are charging patients retainer fees, allowing the doctors to see…

Senn’s past battles shape campaign for attorney general
Tuesday, October 26, 2004 : Local News
Deborah Senn’s bid to become Washington’s attorney general has morphed into something of an anti-campaign. Instead of offering the usual litany of groups who support her, the Democratic…

Paramount Pictures was briefly interested in doing a movie about our story.

Tory became something of an health care reform activist after the wedding…

A PATIENT SPEAKS OUT ON MEDICAL RIGHTS BILL.(News)
Subscription – Seattle Post-Intelligencer (Seattle, WA) – HighBeam Research – Feb 12, 1999
Also testifying at the Senate committee hearing was Victoria Doyle, a heart transplant recipient who recently won a battle with her insurance company, …

DEMOCRATS TRYING AGAIN TO GIVE PATIENTS MORE CONTROL OVER …
Subscription – The Columbian – HighBeam Research – Feb 12, 1999
Victoria Doyle, a heart-transplant patient from Tacoma, said she has had to fight for life-supporting medication since her 1991 operation. …

HMOs Go Under The Knife: America has perhaps the world’s best …
Subscription – Newsweek – HighBeam Research – Nov 8, 1999
Victoria Doyle, 42, who lives in Tacoma, Wash., describes herself as “a nightmare for the insurance industry.” Ever since her heart transplant in 1991, …

SENN BACKS DRIVE FOR PATIENT RIGHTS HEARINGS BEGIN NEXT WEEK ON …
$2.95 – Spokane Spokesman-Review – NewsBank – Jan 7, 2000
Senn and Schual-Berke were joined by heart transplant patient Victoria Doyle of Seattle, who lost insurance coverage for the drugs that keep her body from …

HOUSE OKS HEALTH BILL TO LURE INSURERS BACK BUT CONSUMERS MAY PAY …
$2.95 – Spokane Spokesman-Review – NewsBank – Mar 4, 2000
“Frightening,” said Victoria Doyle of Tacoma, a heart-transplant patient who has been following the individual insurance debate. …

Senn brings Senate bid to town
$2.95 – Bellingham Herald – NewsBank – Jun 25, 2000
On Saturday, Victoria Doyle of Brown’s Point in Pierce County and Dylan and Christine Malone of Everett came to Bellingham to try and convince those at a …

Tory’s efforts contributed to the Washington State Patient Bill of Rights.

Health Insurance – Patients’ Bill of Rights Protects Consumers
The Patients Bill of Rights for Washington (SB6199) passed the legislature with … Victoria Doyle of Tacoma is a heart transplant survivor who was abruptly …

To this day she continues to lobby on health care reform and insurance issues. Tory even briefly appeared on campaign commercial when Deborah Senn unsuccessfully ran for Washington state Attorney General. Tory’s part is when she says, “Thanks to Deborah Senn, I got the heart medication I need.”

I don’t think Regence ever knew that I started our little David and Goliath war. My involvement was quietly drowned out by all the noise, something I’m very happy with. This is the first time I’ve ever documented everything that happened.

The story still hasn’t ended, not really. We, amazingly, are entering into our seventh year of marriage.

We all face challenges in our lives. I guess the message here is don’t give up the good fight. “Something wonderful  (can come) from something terrible.”

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Affaire du coeur, Part 6

So here we were. Plan B no longer necessary 3 days in the nick of time. But our time in combat with Regence formed a bond of more than friendship. I mean, we had been fully prepared to get married. Somehow, we had fallen in love during the ordeal of the previous two months.

We decided to make a go of it. I put in for a transfer, and we began jetting back and forth to Seattle to be together. Our relationship blossomed, and we talked about making the marriage real. I began shipping my belongings to Seattle.

My transfer finally came through in mid-November, and I raced a storm across the country, and eventually the Cascades, with two cats and what remained of my belongings in tow. At one point, one of my cats decided to help steer, which is a more terrifying thing than I can easily describe.

And the Cascades were no picnic from a flatlander Hoosier. Holy cow, these mountains were huge, with writhing roads, and places for runaway trucks to try and stop. My Jimmy coughed and sputtered over the peaks, and ran wild down the other side of the mountains.

I arrived in the morning at the bookstore Tory worked part-time in, at the same time Tory was arriving for work. She hadn’t expected me so soon, and welcomed me gladly, then tried to explain how to get to the apartment from where I was.

Listen, until you’ve driven on I-5 jammed with traffic, then later curvy roads that you’re not used to, with a truck stuffed with a vacuum cleaner (among other things) and two cats, you would not believe how much that seriously sucked.

I finally arrived, unpacked, and waited for Tory to come home.

Now, despite the fact that we had been talking seriously about getting married, we settled in living together for the time. I started my new job with a cut in pay, but I was just happy to be there.

In January, I was struck with a bout of bronchitis. I was already running a fever and was sick as a dog, when Tory asked me out of the blue, “So, do you want to go get married?” Well, as that was kind of the whole point, I eagerly said yes.

She made the arrangements. Something involving Druids. Seriously.

We contacted Shelby with the Times, as she had asked us to do if we ever did get married. Then I dragged my feverish self off to a cold beach, and the following article was the result.

This article is available at:
http://archives.seattletimes.nwsource.com/cgi-bin/texis.cgi/web/vortex/display?slug=4002399&date=20000131
and reproduced here in whole without permission.

Monday, January 31, 2000
A fairy-tale romance with a park wedding
Shelby Gilje

Seattle Times Troubleshooter

Victoria Doyle and Jack Huster were married yesterday in West Seattle’s Lincoln Park, more than a year after he proposed marriage to help solve insurance problems she has as a heart-transplant survivor.

But yesterday’s “we dos” had nothing to do with insurance. Doyle and Huster’s story is a romantic fairy tale, certainly equal to scripts written for Meg Ryan and Tom Hanks.

With gray skies above, the waters of Puget Sound lapping against the beach and an occasional Fauntleroy-Vashon ferry passing by, Doyle, 42, -and Huster, 36, were married by priests of a local group associated with the British Druid Order. (Druids, an intellectual and religious caste among the tribal peoples of pagan Europe, were the custodians of cultural and spiritual heritage.)

Yesterday, layered clothing was the fashion, with Doyle wearing black jeans and a turtleneck, a black fur hat and a long, burgundy embroidered vest. The bridegroom rolled up his trouser cuffs to reveal thermal underwear.

“Taking their vows

Before the couple spoke their vows, the approximately 60 people attending marched around the beach in opposite directions, then formed a circle.

Kathie Brooks, priestess and goddess guardian for the ceremony, asked the couple:

“As the sun and moon bring light to the Earth, do you Victoria and Jack vow to bring the light of love and joy to your union?”

“We do,” the couple answered in unison.

“And do you vow to honor each other as you honor that which you hold most sacred?”

“We do.”

“And do you vow to maintain these vows in freedom, for as long as love shall last?”

Again they said, “We do.”

Then Gordon Goodykoontz, priest and god guardian, said:

“Let the stone bear witness that Victoria and Jack are joined in love and joy and freedom!”

Those in the circle followed with, “So let it be!”

Fairy Tale Wedding

Meeting online

Doyle and Huster met a couple of years ago in an Internet chat room. They had much in common; she understood and appreciated his wit and he understood hers.

“It was common weirdness,” Huster said. They liked some of the same books and riddles. By July 1998, they communicated so well they decided to meet – in person. They chose a Borders Books coffee shop in Chicago.

Though they had exchanged photos on the Internet, Huster said he had difficulty believing the woman he had corresponded with was so beautiful.

On the way to their date he told himself, “Yeah right. What am I doing? I should turn around.?”

After that meeting their relationship blossomed and they kept in touch via e-mail and phone. Just before Christmas 1998 she received some bad news.

It appeared that Regence BlueShield, her insurance carrier, no longer would pay for the anti-rejection drugs that have kept her alive since the heart transplant in July 1991.

With only three days of drugs on hand, the news was virtually a death sentence. Huster found it particularly intolerable, because his first wife, Kathy, died of a heart condition in 1987. It didn’t seem fair that it would happen again to someone so close.

Huster, a Fort Wayne, Ind., postal worker, made a proposal: If Doyle’s insurance would not cover the prescriptions, he would marry her and provide insurance that would pay.

“I wasn’t going to stand by and see her die,” Huster said.

He sent her papers to complete for a marriage license and reserved a date with a judge.

In the meantime he peppered the media – including The Times Troubleshooter – and the state insurance commissioner’s office with e-mails and faxes about Doyle’s plight.

Then Regence had a change of heart and decided to pay for the drugs.

While that was great news, it came as a letdown for the would-be bridal pair.

“I almost didn’t want to tell him it was going to work out. We were both a bit disappointed when we didn’t have to get married,” she said.

Huster canceled the date with the judge but had second thoughts, too. He remembers telling a co-worker in great detail about Victoria. The co-worker made him realize that he had strong feelings for her.

“I guess I need to have a piano drop on me before I realize certain things. I finally thought to myself, `So what do you want, Jack, a burning bush to tell you what to do?’ “

Last November, Huster packed up his cats and household goods, took a pay cut from his job with the U.S. Postal Service and relocated here.

Yesterday the grinning bridegroom said:

“No, we’re not getting married just because of the insurance.”

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Affaire du coeur, Part 5

Well, everything worked out, didn’t it? Not quite.

A few days later, Regence again turned down Tory’s coverage for other medications required as a result of the transplant. Regence claimed that these secondary medications weren’t covered under her transplant insurance.

We had been through this once, and this time I wasn’t going to waste time calling, faxing, and writing the people who didn’t respond the first time. This time I contacted the Seattle Times and the Insurance Commissioner’s office directly.

Again, Plan B was resurrected, except this time, we had even less time than before. We were already at the deadline we had originally set for Plan B, and set it in motion again with real intent to follow through with it.

Pressure was applied to Regence. And again, Regence blinked.

This article is available at:
http://archives.seattletimes.nwsource.com/cgi-bin/texis.cgi/web/vortex/display?slug=2939659&date=19990120
and is reproduced here without permission.

January 20, 1999

Troubleshooter
Insurer Bumbles Question About Drug Coverage
Shelby Gilje

Seattle Times Staff Columnist

Get it all in writing!

That’s the best advice I can give a consumer whether it’s Victoria Doyle, a heart-transplant survivor, who has been in a complicated dispute with an insurance carrier over drug coverage, or someone who can’t get a widget they ordered.

Ten days ago, it appeared that Doyle’s dilemma was resolved. Based on a letter Regence BlueShield sent to Don Sloma, a deputy in the state Insurance Commissioner’s Office, I wrote that the carrier had decided the transplant benefits in Doyle’s policy would cover medications she needs to survive – immuno-suppressants and drugs to control cholesterol, blood-pressure and stomach acid.

But just three days later, Regence reversed itself, saying it had approved only the immuno-suppressants Doyle requires, under her $200,000 lifetime transplant benefit. The other medications would be charged against her prescription coverage, which is capped at $500 a year, leaving Doyle to pay $4,300 a year out of pocket.

Regence spokesman Chris Bruzzo explained that the health plan’s pharmacists ruled the other drugs were not related to the heart transplant.

But Doyle says her physicians contend all these medications are required because of the transplant. And, she adds, she did not have high blood pressure or cholesterol, or stomach-acid problems before the transplant.

Bruzzo said the first letter to Sloma, signed by Waltraut Lehmann, Regence’s manager of regulatory affairs, dealt only with the immuno-suppressant drugs. The other medications were reviewed separately.

“We were not aware of the other drugs that she felt ought to be applied (to the transplant benefit) and we should have taken a broader view of all her medications,” Bruzzo said.

“The positive thing is we did review it and we have approved all seven drugs. And we are apologizing to Doyle for the challenges.”

Lehmann’s initial letter did not single out the blood-pressure, cholesterol or stomach-acid drugs for added review.

It said, in part:

“We did not recognize that her drugs should be counted against her transplant benefit, instead of her retail-drug benefit. Consequently – we are sorry to say – she was informed that, when she reached the $500 limit on her retail-drug benefit, her medication would no longer be covered.” The letter mentioned a billing problem, but said it would be corrected. There was no hint that the review of coverage would continue and that a different outcome was possible.

“We took that (Lehmann’s first letter) to mean an `all clear signal,’ ” said Jim Stevenson, a spokesman for Insurance Commissioner Deborah Senn.

Lehmann’s second letter to the insurance commissioner’s staff said Regence’s decision was final: the added medications were not transplant-related. Lehmann said she understood Doyle would appeal.

Doyle said when she asked Regence and the insurance commissioner to review her coverage, she asked about all the transplant-related medications, not just the immuno-suppressants. But Doyle acknowledges that she made that request over the phone, not in writing.

Frankly it doesn’t make much sense to me to tell a consumer they are covered one day, then inform them a few days later that they are only partly covered.

It’s also odd that Regence has been paying for all of the medications since Doyle bought the policy in November 1996. Doyle says she always has purchased the medications through the pharmacy at the University of Washington Medical Center, where she had the transplant in 1991.

No one could explain the change of heart to me.

When Regence seemed to be reneging on its promised coverage last week, the insurance commissioner’s office re-opened its probe.

I made some more phone calls. Among other things, I asked Regence for a letter that specifies what drugs it will charge to Doyle’s transplant benefits.

Doyle says if she has future questions about coverage, or gets phone calls she will ask for everything in writing.

Doyle’s dilemma is one more reason to support the insurance commissioner’s proposed rules for more drug-coverage disclosures by insurance carriers – before consumers sign up for health plans.

Shelby Gilje’s Troubleshooter column appears Wednesday and Sunday in the Scene section of The Times.

Copyright (c) 1999 Seattle Times Company, All Rights Reserved.

This time, Regence finally covered Tory’s meds. She had literally 3 days worth of meds left, before the final word came through. Imagine having 3 days left to live.

We weren’t going to have the last word, though. The medical director at Regence, decided have something positive to say about Regence.

This article is available at:
http://archives.seattletimes.nwsource.com/cgi-bin/texis.cgi/web/vortex/display?slug=2939588&date=19990120
and is reproduced here in whole without permission.

Editorials & Opinion: Wednesday, January 20, 1999
Doctors And Health Plans: Making The System Work
Donald Storey

Special To The Times

I’M a physician, so I know precisely the importance of a great doctor-patient relationship. People get the care they need, when they need it. And they stay healthier. When you like your doctor and trust what he or she has to say, and they listen to your concerns and needs, it makes all the difference in the world.

I was 20 years in private practice in internal and pulmonary medicine. Now, I’m the medical director at Regence BlueShield, our state’s leading health plan, with more than 1.1 million members.

So, when I heard some doctors – even those who are friends and longtime trusted colleagues of mine – characterizing a new contractual agreement we distributed last summer to providers in this state as a “master-slave relationship,” well, that didn’t sit too well with me.

I’ve worked with health plans my entire medical career; on occasion I have disagreed with them. But I was never their slave. And I was never told how to practice medicine. I would not tolerate that when I was in private practice, and I won’t tolerate it as medical director at Regence BlueShield.

That’s why when I felt the backlash from my colleagues last summer, my one and only reaction was this: We need to find a better way for doctors and health plans to work together. Period. We must have enough of a partnership to come together, with trust and credibility, to resolve those problems. That’s what is best for our patients and health-plan members.

We listened to physician leaders from groups such as the Washington State Medical Association and the Pierce County Medical Society, as well as many individual providers and practitioners who had voiced their strong concerns about our newest contract. And then we got to work on making changes to our contract.

We went back to the physician leaders in our state and showed them the changes. Case in point: On several occasions, we met with the executive director and president of the Washington State Medical Association, the most vocal critic of our initial contract distributed last summer. They gave us input, were given comprehensive reviews of our revised contract, and given time for additional response and comment.

We’ve made the first move to the physician community in this state – taking the negative feedback from doctors on our new contract and going back to doctors for input and review. What’s more, we are committed to this path.

Physicians in this state probably won’t say our revised contract is perfect or that every word suits their purposes. And that’s OK. But they will say it is a definite improvement and that we worked together, in good faith, to settle our differences.

So why, if we’ve learned to work better together, can’t all physicians put an unqualified stamp of approval on this contract? This is a business contract and our responsibilities do differ. Physicians are responsible for the medical advice and care they provide to patients. Health plans are responsible for taking the premium dollars our members give us each month and ensuring that they are spent in the most efficient and effective manner possible. And we may have, at times, a difference of opinion with our providers over how those dollars are spent.

But the key will be how we settle our differences. At Regence BlueShield, we believe there is a middle ground that will allow us to work together on behalf of patients and members, even when the issues are complex and contentious. We know the issues are tough, and will only get tougher. We will go head-to-head with our physicians and other providers over how much we reimburse them for medical services, among other key issues. Because that’s our responsibility – keeping costs reasonable while ensuring that health-care consumers have access to quality providers and medical services.

Early this year, physicians throughout our state will receive our new, revised contract, and we think they’ll be pleased with the changes we’ve made. They’ll know we’ve listened to their concerns and responded in a positive manner.

We believe we have started to lay a solid foundation of collaboration. Our actions over the latter part of 1998 in working closely with physicians in crafting a fair, responsible contract are a practical example of our future intentions.

We won’t settle for “Us versus Them” anymore. I hope my colleagues feel the same way.

Donald D. Storey, M.D., is medical director at Regence BlueShield, and was a practicing physician for more than 20 years in Washington. He is also a board member of the Washington State Medical Association, the state’s leading physician organization.

Copyright (c) 1999 Seattle Times Company, All Rights Reserved.

This editorial just happened to run at the same time as this last article. It was an attempt to make them look like the misunderstood good guys.

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Affaire du coeur, Part 4

We were finally contacted by The Seattle-Times, which began knocking on a few doors themselves. They started rallying to our cause by rattling Regence’s cage, and working closely with the Insurance Commissioner’s office. I talked to Shelby Gilje at the Times, and went over what I had been doing.

This article is available at:
http://archives.seattletimes.nwsource.com/cgi-bin/texis.cgi/web/vortex/display?slug=2937714&date=19990108
and is reproduced here in whole without permission.

Friday, January 08, 1999
State Wants Insurers To Provide Details On Prescription Coverage
Shelby Gilje

Seattle Times Staff Reporter

The state is investigating a complaint from a consumer with a life-threatening illness who says her insurance carrier stopped paying for her drugs in mid-treatment with little notice.

Insurance Commissioner Deborah Senn did not disclose details of the complaint but cited it as an example of why consumers need more information on the prescription coverage their health plans provide.

Yesterday Senn filed proposed rules for health plans on what insurance carriers would be required to disclose up front to consumers. A public hearing on the proposal is set for Feb. 23. The rules could become effective in mid-March.

Senn is seeking comments from consumers and the insurance, health-care and pharmaceutical industries on about 10 recommended disclosures.

Among them, Senn has proposed that health-insurance carriers provide the following information to consumers:

— Whether the plan limits or excludes certain drugs that may be prescribed by a doctor, and whether substitutions will be encouraged for some drugs.

— When the plan can change the approved drug list or formulary.

— If a change occurs, whether the consumer will have to pay more or could be “grandfathered” to continue with a drug already in use.

— What phone number consumers can call to request a change in coverage or make an appeal.

— What consumers must pay to get a prescription filled.

— Whether their plan requires consumers to use specific pharmacies, and their locations, to pay the least out-of-pocket expenses.

— How many days of medication a consumer gets per co-payment.

Senn’s staff and industry representatives were involved in a year-long task force that studied consumers’ complaints about prescription and mental-health benefits.

Representatives of Premera Blue Cross and Regence Blue Shield were part of the task force and said it was a positive, collaborative approach.

But while Premera wants to support the disclosure recommendations, officials at the insurer said, they’re concerned about the cost of providing information on dozens of prescription plans and whether that detailed information might confuse consumers.

Regence already provides most of the information, said spokesman Chris Bruzzo.

“We are in strong agreement with the commissioner that more information, and direct, clear communications can go a long way to avoid confusion and mixed expectations,” Bruzzo said.

Regarding mental-health treatments, Senn’s proposal also would require insurance carriers to tell consumers what information about them would be disclosed to entities other than medical providers, how many mental-health visits the plan covers and how that coverage can be used.

For more information, see the insurance commissioner’s Web site at http://www.wa.gov/ins or call the agency at 800-562-6900.

Copyright (c) 1999 Seattle Times Company, All Rights Reserved.

Still, it looked like no solution was close at hand, so I began working on Plan B. I had just read Through A Distant Mirror, about the 100 Year War which finally ended by a political marriage. It gave me an idea. If no one could come through for us, I would marry her to get her covered by my insurance policy, which was through an excellent company, with good coverage. I contacted the insurance company to see how soon they could cover a new spouse. They told me immediately.

I started talking to Tory about this plan. She thought it was a workable solution. We set a deadline to get the resolution solved, otherwise, Plan B it was. I contacted the Marriage License department and a local judge and set a date based on this backup plan. She would fly out on the deadline date, and we’d immediately get married, and I’d get her onto my insurance policy. Her only question was if her mom could come to the wedding.

Don’t forget, I was still faxing and mailing and calling everyone I could to resolve the situation without having to go through the backup plan.

Finally, 7 days from Plan B, Regence blinked. The pressure from the Insurance Commissioner’s office and The Seattle-Times, became intense, and they realized they were about to be dragged into the spotlight. Tory told me this on a Friday, I think. We were relieved that Regence finally capitulated, although they covered their ass by saying it was a “clerical error.”

On Monday, as I was getting ready to leave for work, I got a call from Shelby. She told me to sit down, and proceeded to tell me what I had already known, that Regence had agreed to continue Tory’s coverage. She asked me how I felt about this finally happening and I told her I couldn’t be happier. I started checking my watch to see how much time I had left before I had to get to work. We chatted for a while, and then she asked me, “So what’s this about a Plan B.

I told her what my backup plan had been, and she must’ve been paying more attention than I thought.   This is the article as written by Shelby for the Times. They didn’t get everything quite right, but the important parts are there.

This article is available at:
http://archives.seattletimes.nwsource.com/cgi-bin/texis.cgi/web/vortex/display?slug=2937968&date=19990110
and is reproduced here in whole without permission.

Sunday, January 10, 1999
Health-Insurance Gaffe Nearly Fatal — Life-Dependent Drugs Not Covered, Woman Told
Shelby Gilje

Seattle Times Troubleshooter Columnist

Life looked bleak for Victoria Doyle, 41, a heart-transplant survivor, until just a few days ago. But now Doyle’s got insurance.

Just before Christmas, she was told that Regence BlueShield insurance no longer would pay for anti-rejection prescriptions because her policy has a $500-a-year cap on prescription drugs.

Because the drugs that keep her alive cost about $2,000 a month, the news was like a death sentence.

“I’m surprised I didn’t pass out right there in the hospital,” Doyle said.

Over the holidays, Doyle wrote a friend via e-mail that she felt as if she were “standing on a melting ice floe” because of the news that her drugs would not be covered.

On Thursday, Doyle got some good news from the state Insurance Commissioner’s Office. Don Sloma, a deputy commissioner, called Doyle and said Regence would cover her medication under the $200,000 lifetime-transplant benefits in her policy. Regence discovered a billing error, Sloma said.

Waltraut Lehmann, manager of regulatory affairs for Regence, said the carrier has only two other subscribers who are transplant patients, so “it’s a pretty unusual circumstance.” The confusion apparently arose over whether Doyle’s medication should be under the transplant-benefits category or the prescription-drugs category on the policy she bought in late 1996.

Representatives of Regence are working out details with Doyle’s doctors and pharmacists at the University of Washington, where she had the transplant July 4, 1991.

Doyle’s dilemma surfaced Thursday after state Insurance Commissioner Deborah Senn filed proposed rules requiring detailed, upfront disclosures on prescription coverage before consumers buy insurance policies. Senn will have a public hearing on the proposed rules Feb. 23 in Olympia.

“I’m glad for Victoria that we got this resolved, and I commend Regence for fixing it,” Senn said.

Among those Doyle told about her insurance problems was Jack Huster of Fort Wayne, Ind., whom she met through an online chat room about two years ago.

Huster, 35, a U.S. Postal Service data-entry worker, e-mailed the story of Doyle’s dilemma to Washington’s governor, the insurance commissioner, members of the congressional delegation, and local and national media.

“I wasn’t going to stand by and see her die,” Huster said.

Twelve years ago, Huster said, he spent New Year’s Eve with “somebody very special, and she was gone in three months because of a heart condition.” That was his wife, Kathy.

When he heard that Doyle was facing death if she couldn’t get her medication, he came up with a plan: If Doyle’s insurance wouldn’t pay for her drugs, he would marry her so his insurance would cover her.

Huster sent Doyle papers to apply for a marriage license and reserved a date with a judge for a wedding this month.

Doyle was touched by his proposal and caring. “It’s something wonderful from something terrible,” she said.

Copyright (c) 1999 Seattle Times Company, All Rights Reserved.

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