Beyond Measure

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What does a life cost? In 1987, I knew exactly: $150,000. One of my major responsibilities as a hospital department manager was obtaining authorization from insurance companies for bone marrow transplantations. The insurance companies had an equally fierce responsibility to try to deny them. With the help of the oncologists and hematologists I worked for, I wrangled by telephone and mail with authorization specialists for months on end.

Our department had the burden of proving that a given transplant wasn’t experimental, difficult at best since at the time, the procedure’s use was relatively recent. A bone marrow transplant is always a gamble—even the patients know it. I had to learn to find the best bargaining points for each insurance company. For one, a certain diagnosis might carry more weight than another, or they might deny us based on the age of the patient or the duration and location of the disease. Mostly, though, it seemed to me that they said yes or no on a whim. I had worked for health insurance companies previously, and while I had a basis for understanding the abstract number-crunching that went into the decisions, I took each denial personally. I imagined the medical committee who had handed down a “not authorized” verdict as a bunch of devils sitting around a conference table, pitchforks in hand.

For I had met the patients who were waiting for a green light, a magical opening of the gate which would save their lives. I talked often with Stephanie, a mother of three young children, who would gladly endure chemotherapy, transplant and isolation for weeks on end with a mouth too sore to swallow food in order to see her daughters grow up. I knew Steven, a gentle book publisher with lymphoma whose wife pleaded with us to treat him in spite of his now-frail physique. I’d come to know the successful transplant recipients, each of whom seemed burnished by the fire which had nearly destroyed them. Surviving a bone marrow transplant is akin to going through a nuclear war, and the toll on bodies and psyches is almost impossible to fathom. Those who make it through the first year seem to glow with a new light after they’ve put the nightmare time in the hospital behind them.