On the radio, I recently heard the story of Thomas Concannon, who suffers from a rare cancer called multiple myeloma. His physician, a professor of medicine at Tufts University and director of the bone marrow transplant unit at Tufts-New England Medical Center, recommended that he receive a bone marrow transplant from his sister. Concannons insurance company, CIGNA, informed him that since the treatment was experimental it was not covered by his insurance, even though his physician states that a bone-marrow transplant is the preferred form of treatment for this condition. Concannon has just had an appeal upheld that requires CIGNA to pay for the $200,000 treatment.
UCAR has just changed healthcare providers to CIGNA. This story has me wondering about what would happen to a UCAR employee under similar circumstances. I also understand that CIGNA declines to cover the rehabilitation of stroke victims.
I would like to know if a similar situation could arise with the plan provided by CIGNA. Furthermore, I would like you to indicate what help and assistance UCAR would provide to employees should they have the misfortune to find themselves in a similar dispute with their healthcare provider.
Both the CIGNA HMO and PPO plans offered through UCAR cover autologous bone marrow/stem cell transplants. As with any transplant, each case must be reviewed thoroughly, and a transplant case manager would be assigned.
All the specifics relating to Concannons case are not available to the general public. Because each case is different and we do not know about the CIGNA contract in this case, its difficult to speculate about the reasons for denial.
If a transplant is approved for a UCAR employee, the services include the recipients medical, surgical, and hospital services; inpatient immunosuppressive medications; and the costs for organ procurement. These services are only covered when they are required to perform any of the following human-to-human organ or tissue transplants: allogeneic bone marrow/stem cell, autologous bone marrow/stem cell, cornea, heart, heart/lung, kidney, kidney/pancreas, liver, lung, pancreas, or small bowel/liver. The HMO plan charges $200 per admission to the hospital and pays 100% thereafter. The PPO plan has certain other limitations. The lifetime maximum for a bone marrow transplant is $130,000. Other issues addressing travel to a transplant facility and donation are covered in the plan documents.
Like many other health insurance plans, the UCAR CIGNA plan does exclude experimental procedures. In general, experimental, investigational, or unproven services are excluded if they are
Both CIGNA plans have a formal appeal process if a proposed transplant should be denied. UCAR encourages employees to pursue the formal appeal process in the event of a denial.
The questioner also mentioned rehabilitation for stroke survivors. Once again, each case is different and would be thoroughly evaluated. In general, medically necessary physical therapy, occupational therapy, speech therapy, and feeding therapy would be covered. Each type of coverage has certain limitations.
This response offers general information about the issues raised. Please address specific questions regarding transplant issues to me or to CIGNA directly. The CIGNA plan documents are in the process of being prepared and made available on the Web. If you have more specific questions about the issues raised in this Delphi question, please contact me at ext. 8702 or firstname.lastname@example.org.
Laurie Carr, manager Human Resources
It's another drought year in this already desert environment. Why does the nation's premier weather and climate research facility still have large lawn areas that require additional irrigation beyond what nature provides? And then, to add insult to injury, these lawns require routine manicures throughout the growing season with terribly polluting and noisy equipment. The xeriscaped area in front of FL2 is quite nice. Could that be expanded to displace more (if not all) of the lawn areas? If the lawns were sufficiently small, a push mower could handle the job. Shouldn't UCAR be setting a better example for Boulder and the rest of the Front Range? Beyond lawn care, shouldn't we also insist that other groundskeeping be done without leaf blowers and their icky ilk?
Most of the landscaping at the Foothills Lab complex, with the exception of the xeriscaped portion in front of FL2, came with the purchase of the property. Although we are allowed some leeway in the design and layout of our landscaping, much of what you see at Foothills Lab was the result of the land use regulations adopted by the City and County of Boulder that were in force at the time of the original construction. The current regulations have been revised to address water conservation and the use of xeriscaping, but any plans to modify our landscaping would need to be reviewed and approved by the citys planning board. Planning efforts, currently on hold, for an additional building at the Foothills site do include modifying much of the landscape to meet current requirements. While xeriscaping is a fine alternative to lawns, it does require extensive maintenance to keep it looking presentable.
UCAR is currently limiting our irrigation of the Foothills landscaping to meet the City of Boulder mandatory water restrictions that went into effect on June 5, 2002. In addition, we have instructed our lawn service contractor to keep our lawns as tall as possible to minimize evaporation.
Air-polluting, two-cycle gasoline engines typically powered older lawn care equipment. The larger equipment used by our contractors and UCARs Maintenance Department is powered by four-cycle engines to meet the U.S. Environmental Protection Agency's clean air specifications.
The criticism of leaf blowers largely results from the fact that they are powered by two-cycle engines. The labor savings that is realized by the use of leaf blowers is certain to ensure their continued use by contractors and maintenance departments. However, the tool industry is responding to the publics concerns by producing versions of leaf blowers that will meet tough new EPA emission regulations that take effect this year. Physical Plant Services will be replacing its leaf blowers with the compliant models as soon as they become available.
John Pereira, director Physical Plant Services
My question is about the fountain at the Mesa Lab. I have heard that the fountain uses hundreds of gallons a day. As of yesterday the water was gray from the ashes in the air, and they will be cleaning it out soon. I believe that since we are in the middle of the worst drought in 100 years, we should set a good example of water conservation and turn it off for the time being. We need to lead by example, wouldnt you think? Thats why I was hoping to get something resolved before they fill it up again and waste more precious water.
We're going to shut down the fountain due to mandatory water restrictions in Boulder. Although the water in the fountain is recycled, in the recent hot weather the fountain lost, on average, 117 gallons per day to evaporation. We will turn the fountain back on when the water restrictions are lifted. Thank you for your concern.
Tina Bogott, project manager Mesa Lab Refurbishment Project
Questions and suggestions from the staff to management may be submitted in confidence to the Delphi Coordinator. They should be submitted in written form, preferably via interoffice mail in a sealed envelope marked confidential. They must be signed. Detailed procedures for submitting questions are given in the UCAR Policies and Procedures Manual, section 4-1-2. Questions and answers of general interest to staff are submitted to Staff Notes Monthly by the Delphi Coordinator. They may be edited for publication. For more information, including links to questions and answers published in SN Monthly and a log of all questions submitted since 1995, see the Delphi Service Web page.
Edited by David Hosansky,
Prepared for the Web by Carlye Calvin
Last revised: Mon Aug 19 17:08:40 MST 2001