Otto Tang Fights for His Life

But instead of battling leukemia, Tang battles
insurance representatives

by Todd Matthews, Free Press Contributor

n late-September 1998, Otto Tang came down with a cough. At first, there was little concern about the ailment. Tang was, after all, a championship swimmer, on course to break several Roosevelt High School records. But Tang's cough didn't go away. He grew more tired after swimming or playing basketball. He knew there was something wrong with his health. "The doctors put me on antibiotics," Tang said, "but that didn't work. Then they took blood samples."

Tang was diagnosed with acute myeloid leukemia, the disease that killed Seattle School Superintendent John Stanford. Tang endured several months of chemotherapy, but with no success. He relapsed. His doctor recommended a new, targeted kind of chemotherapy--calicheamicin therapy--and eventually a bone-marrow transplant.

But Tang didn't undergo the new therapy. Instead of battling leukemia, Tang battled insurance representatives. NMTA Medical Trust (Tang's insurance provider), HealthComp (the third-party administrator for Tang's father's insurance), and Innovative Care Management (which handles reviews and appeals) denied supportive care for Tang.

In a letter addressed to one of Tang's doctors and dated April 2, 1999, a claims manger for NMTA wrote, "[Otto Tang's Medical] Plan specifically excludes services, supplies or charges that are experimental/investigative in nature or complications arising from such treatment. Based upon the information you have submitted in this case, it would appear that the proposed treatment with calicheamicin [therapy]...and related support care for Otto would be considered experimental/investigative and would not be an eligible expense under the Trust."

Less than a week later, HealthComp wrote, "After reviewing your letter and additional documentation regarding the proposed treatment, it is determined that such treatment is experimental and investigative in nature. Please be advised that the plan document specifically excludes treatment that is experimental or being investigated. In addition, this plan specifically excludes any services done in conjunction with such treatment. Therefore, it is our determination, based upon the plan document, that the supportive services would be an integral part of this research study and would not be reimbursable under this plan."

Calicheamicin therapy was deemed "experimental" for pediatric patients. According to Dr. Eric Sievers, pediatric oncologist at Seattle's Fred Hutchinson Cancer Research Center and one of Tang's doctors, the results of calicheamicin therapy have been "reasonably good" with a high rate of remission and fewer side effects and hospitalizations--despite the fact that it has not yet been approved by the federal Food and Drug Administration. But those are the results of adults, not children, who have undergone this form of treatment. If Tang were to participate in calicheamicin therapy, he would be only the second pediatric patient to undergo such treatment.

In a letter to HealthComp, Dr. Sievers argued that such treatment would most likely help the insurance company. "The reduced morbidity observed with this approach is quite appealing," Dr. Sievers wrote. "Since Wyeth-Ayerst Research is paying for the drug, and it's infusion, it is anticipated that the charges for brining this patient's leukemia into remission will be significantly less than those associated with conventional agents."

This is a truly bizarre aspect of Tang's plight. HealthComp has denied coverage, not for treatment but for subsequent bills incurred by things such as blood tests, possible hospitalizations if Tang becomes ill, and supportive care that any chemotherapy patient might require--in total, an anticipated $83,000. Simply put, it is the first instance that Dr. Sievers can recall wherein an insurance carrier has refused to allow a subscriber to participate in a treatment program wherein the insurance company is not paying for the drug. Moreover, it is strange that HealthComp would deny coverage for a drug it is not paying for and one that would, most likely, save the company a great deal of money.

The decision made by HealthComp and Innovative Care Management is currently being appealed by Tang's family and physician, and investigated by the state Insurance Commissioner.

Tang's family borrowed $83,000 from a former employer based in Hong Kong and the Otto Tang Medical Fund has been established with Seafirst Bank. In May, three bone marrow drives were held, with more than 140 people donating blood--an impressive number, the family said, as not many people of Asian or Pacific Islander descent donate blood. Although these drives were to find a match for Tang, they also helped create a larger bone marrow match bank for other Asians or Pacific Islanders suffering from leukemia.

Donations can be made to the Otto Tang Medical Fund at any Seafirst Bank. To donate bone marrow, contact Puget Sound Blood Center at 1-800-266-4033.