Sunday, January 10, 1999 - Page updated at 12:00 AM

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Health-Insurance Gaffe Nearly Fatal -- Life-Dependent Drugs Not Covered, Woman Told

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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