Woman with willing liver donor fighting to have rare treatment covered by insurance

By CNN Newsource

Published April 12, 2021 12:58 pm

CHICAGO (WBBM) — After a devastating diagnosis, a Humboldt Park woman was desperate to find a treatment that would allow her to see her daughters graduate high school. She found it, but her health insurance said no twice.

But CBS 2’s Marie Saavedra started making calls and learned there may still be a solution.

When Kathleen Lyons and Eileen Womack get together, their days at the University of Illinois don’t seem all that long ago.

“She’s just very lively, very caring and a true friend,” Eileen said.

“Her and I were always the ones up late at night drinking our tea, studying and goofing off,” said Kathleen. “The years go by and we’re still doing that, so we’ll probably go for a cup of tea after this interview.

But in the years since, life happened, and it dealt Kathleen a serious blow two years ago. She was diagnosed with stage 4 colon cancer that spread to her liver.

“I’m surprised I’m still here today, honestly,” Kathleen said. “It’s not going to stay like that without some other intervention.”

She started chemotherapy, and connected with a doctor 600 miles away who gave her hope.

“Their outcomes were above 60% survival at five years,” said Dr. Roberto Hernandez-Alejandro.

He is chief of transplantation at the University of Rochester Medical Center in New York. It is one of only a few in the United States that offer liver transplants for those in Kathleen’s condition with a living donor.

Who knew one of the girls from college, would get in a hospital gown to help the other add years to her life?

“The transplant nurse asked me, she said, ‘Would you like to call Kathleen or would you like us to?’” Eileen said. “I said, ‘I want to call her.’ It was amazing to be able to say, ‘I passed. We’re going to do this!’”

“You know, it means more years with my daughters and everything, and it’s just amazing how selfless she is to do that,” said Kathleen.

But that happy ending was too easy. Kathleen applied to her insurance, Blue Cross Blue Shield, to get the surgery covered.

“They said no to the initial request for the preauthorization of surgery claiming I wasn’t in liver failure,” Kathleen said.

She appealed it, but was again denied. The procedure is rare. BCBS called it ‘experimental’.

“It’s not experimental at all,” said Dr. Roberto Hernandez-Alejandro.

Thursday, CBS 2 reached out to the company for more about that but didn’t immediately hear back.

Still after that setback there is new hope. Just as the ladies were pulling up for the interview with CBS 2, Kathleen got a call from Blue Cross Blue Shield. She says they told her they are looking at new ways to help her.

“I’m hopeful. Very hopeful,” she said.

Whatever that next step is, she’ll take it with Eileen at her side.

“I really look forward to the day we actually do it and we really hope it’s soon,” Eileen said.

Blue Cross Blue Shield responded to CBS 2’s request for more information Friday afternoon with this statement:

As a matter of privacy, Blue Cross and Blue Shield of Illinois does not publicly disclose our members’ personal or benefit information, but instead seeks to work directly with our members on any questions they may have regarding their coverage.

Our members are at the center of all that we do and we are committed to providing our members access to quality health care consistent with the terms of their benefit coverage and any applicable medical policies. Those policies are based on evidence-based standards of care, including, when relevant, the National Comprehensive Cancer Network® (NCCN) Guidelines.

If a member questions a benefit determination, we encourage them to file an appeal for a review of the decision.

For more information on how to help Kathleen’s fight against her cancer, find her GoFundMe here.

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