BMT or SCT

[Lolam]

My insurance company does not pay for stem cell transplants. Do many of you get bone marrow transplants or stem cell? I really can’t remember which one the doctor mentioned yesterday. My hearing was off and on (difficult conversation)…

They are having a conf. on Wed. at Seattle for my case. It is difficult since Ihave had a recurrence of BC a couple years ago. Stable now, but more than likely it would return after a transplant and it would be difficult to control. I have many abnoramal chromosomes also. Therapy induced MDS is not staged like the other. It will be difficult to control. I will move rapidly to AML. That is why we will have to decide how risky to be or when to quit. If I need a SCT it has already been decided. We do not have 256,000 in the savings account!

[DonUK]

Hi Lola – I’m no expert in these matters but I wouldn’t have thought there would be a vast difference in cost between a BMT and Stem cell transplant ? Anyway I guess that’s by the by.

As far as I am aware, the difference is in the cell harvesting (a BMT is done from the marrow itself whereas the SCT is done from the peripheral blood). Thus the recipient treatment is no different. In terms of success rates etc, I believe ther is no marked difference.

What may differ is the type of transplant in terms of the protocol/regime.

In the UK for BMT’s the “mini transplant” (less heavy dose of chemotherapy) is becoming popular for patients who are at risk of tolerating a full blown BMT (i.e. radiotherapy + high dose chemo). My partner is just in the process of recovering from one of these (she had a marrow harvest rather than stem cells) and is doing well (it’s only day 12 at the mo). Again in terms of success rates there appears to be little difference between a mini and a full blown BMT, but as minis are fairly new, there is less data around.

I’m sure others will add to the posting, however I guess you need to ask some fairly searching questions in Seattle such as risks of procedure, cure rates, risks of not having a transplant etc. Hopefully this will guide you in your decision.

I hope this helps a little bit and wish you all the best. May God bless you.

[geebeebee]

Lola, see if you can get the clinic to go to bat for you. My Mom had two opinions from two centers that were virtually the same, so the insurance company went ahead and approved it.

It’s really kind of ridiculous that they would approve a BMT but not an SCT. If they’ve kept up with the times, they would discover that the majority of transplants are SCTs, as they are easier on the donor (and don’t require a hospital stay, as true BMTs often do), and I believe have some receiver benefits as well. Other than the way in which the cells are extracted, there aren’t many differences at all between the two procedures, as I understand it.

I suspect that the insurance company is being difficult…can you talk to the Seattle center and see if they can give them a call? I think it would be worth a try. I know in Mom’s case, they would get pretty gruff with the insurance folks until they buckled.

The way we treat people who desperately need healthcare in this country is criminal — big insurance co’s will look for any excuse to not cover (but I won’t get started on that soapbox).However, I wonder if you can win in this case.

If there is anything we can do to help (I am a tenacious letter-writer), just let us know. This kind of thing makes me angry!

Take care of yourself and we’ll be thinking of you,

Greg

[Suzanne]

I have heard of others that initially had a problem with coveragefor either kind of transplant and in the end did get it covered. If this is a treatment recommended by your doctors don’t give up. As soon as my insurance company saw the blood tsts being done that meant an expensive procedure was being considered they assigned a “case manager” (outside mediator) to my case. This person had a medical background,kept track of my condition and treatment-deternined whether the treatment was reasonable, was in direct contact with my medical personel and negotiated for me when needed with the insurance company. It was wonderful. They were paid by the insurance company but I felt I had a reasonable, medically knowledgable, advocate. Ask for one if you can.

[Jimbob]

Lola,
As far as BMT vs. SCT, many centers do SCT almost exclusively but still refer to it as BMT. You may have gotten an insurance compnay rep who is overly sensitive to the phrase “stem cell” and did not consider anything beyond disgust. Try again and ask for a supervisor or transplant coordinator. SCT is not experimental nor does it come from fetal cells; it is a standard medical practice. IF that does nto work, get the hospital involved in asking about coverage. The social services dept did it for me. And I did get a transplant cooridinator from the insurance company right away.

Good luck and prayers.
Jim

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