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Cancer patient falls behind with treatment after insurance company refuses to pay
December 4, 2007
BY CLARE WALTERS
Cyril Strezo knew something was wrong when he began to choke on everything he tried to eat.
A seemingly healthy man known for taking as much as a half-hour to build the perfect salad, the 58-year-old never smoked or drank alcohol and said he was startled to learn cancer was ravaging his esophagus.
"I never dreamed that I'd have cancer," he said of his June diagnosis. "I thought I'd have a bad heart because that runs in my family."
Wrapped in a beige blanket in his Frankfort home, Strezo was not feeling well Monday morning. He took a few questions and photos for about 10 minutes before he grew too ill to continue. However, he's eager to begin a second round of chemotherapy scheduled for today.
"I'm already three weeks behind," Strezo said.
His insurance company, UniCare, is refusing to pay for two chemotherapy drugs. The company has deemed them "experimental and/or investigative" relative to his treatment.
Lawrence Schilder, Strezo's oncologist at Midwest Center for Hematology/Oncology, said these drugs are the best available for Strezo.
Tony Felts, spokesman for UniCare, said he cannot address a specific client's case due to privacy practices, but experimental or investigational treatments are excluded from coverage under the benefit plans.
Schilder said insurance companies deny medications for his many patients at least two or three times a week on those grounds.
"It doesn't seem appropriate that you're telling the doctor how to do medicine," he said. "If this was your father, would you want to be treated this way?"
Schilder said most times doctors are forced to select a less effective drug for their patients, which also happened to Strezo during his first round of chemotherapy. Strezo first underwent eight weeks of radiation and chemotherapy beginning July 3.
Schilder said one of two drugs prescribed for that course of treatment was denied by UniCare, again for being "experimental and/or investigative."
The oncologist said he appealed to the insurance company on Strezo's behalf, but ultimately decided to use a "less than optimal" drug to ensure insurance coverage.
In late August, treatment results were positive and showed Strezo's tumor had shrunk enough to allow an esophectomy, where the esophagus is removed and replaced with a section of the stomach. Midway through the Oct. 11 surgery, a surgeon told the Strezos that a tumor had grown on Cyril's liver. The surgeon removed the affected tissue, but in just over a week the tumor grew back. Two weeks later, a second tumor was located on the liver.
Schilder's new course of treatment was to use Cisplatin and Irinotecan, chemotherapy injections used to treat various types of cancers.
This time, UniCare issued a denial letter for both drugs.
Schilder said when a drug company creates a drug, it markets and gets Federal Drug Administration approval relevant to a specific ailment. However, drugs marketed for one type of cancer are effective and routinely prescribed by doctors for other types, which is Strezo's situation, Schilder said.
"They (UniCare) hope the situation solves itself when the patient passes away," he said. "I'm outraged by the whole thing. We really don't have a whole lot of resources, but we'll continue to jump through their hoops."
Jody Polka, one of Strezo's daughters, has filed an appeal with UniCare on her father's behalf and provided them with published studies validating the use of these drugs for Strezo's cancer.
Felts said appeals are handled by practicing, board-certified physicians, and a decision is typically rendered in 30 days. But the Strezos can't wait that long.
"His cancer is not curable, but that doesn't mean it isn't treatable," said Polka, who maintains a three-ring binder full of paperwork and correspondence with UniCare. "You just have to fight, fight, fight."
The treatments will cost the Strezos $3,000 per week. Depending on how Strezo's body responds, treatment could last anywhere from eight weeks to six months.
Polka said cancer has changed her father's life drastically.
The father of three and grandfather of two has lost close to 100 pounds since his diagnosis. Strezo is a frail image of the man pictured in a 25th wedding anniversary photo with his wife, Terry. The couple have been married 36 years.
As part owner of a trucking and excavation company, he would work from 6 a.m. to 7 p.m. every day. Any free time was spent with family and a slew of friends, who well know of his die-hard love for the Green Bay Packers and White Sox.
He loved to eat, but his meals now are a fraction of what a 6-year-old would eat, Polka said.
He hasn't worked in six months and missed his grandson's wrestling tournament Sunday for the first time in three years.
"He'd do anything to have a salad and not be sick," she said.
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