Divorce May Save Her Life Insurance Won’t Cover Cost Of Transplant, But Medicaid Would

Doctors tell Nikki Manipon she needs a bone-marrow transplant, but she may have to divorce her husband to get the life-saving procedure.

Manipon, 25, of Federal Way, doesn’t want to do it. She and her husband, Gil, have been married seven years and have three children.

While the Manipons’ health insurance will only cover $50,000 of the $250,000 procedure, if Mrs. Manipon were a single mother with three children, Medicaid would pay the bill for the transplant.

Manipon was diagnosed with myelogenous leukemia in September. The disease will be fatal unless she receives a bone-marrow transplant within a year, said Dr. Jay Klarnet, director of the bone-marrow transplant program at St. Joseph Medical Center here.

On the day she was diagnosed, Mrs. Manipon learned that her husband’s insurance would not pay for the procedure, which Klarnet said is standard treatment for the disease.

More than two-thirds of patients who get the transplants within a year of diagnosis are cured, Klarnet told The News Tribune of Tacoma.

Average cost for a transplant and finding a donor is $250,000, said Susan Edmonds, spokeswoman for the Fred Hutchinson Cancer Research Center in Seattle.

“It’s not right that I could be cured, and they won’t allow it,” Manipon said.

“It’s a really expensive procedure, but if it saves your life, isn’t it worth it?”

Klarnet suggested the Manipons divorce so she could qualify for Medicaid as a single mother. Their children are 6 and 5 years and 19 months old.

With prior approval, Medicaid pays for bone marrow transplants that are medically justified, according to the state Medical Assistance Administration.

“It’s really scary,” said Manipon, who is currently taking chemotherapy drugs.

Manipon works for Sea-Land Service Inc. and is insured through his union, the Seafarers International Union. His policy excludes bonemarrow transplants.

“The plan doesn’t cover the cost of any transplant, whether heart, kidney, liver or bone marrow,” said Seafarers spokeswoman Jessica Smith.

But when the Manipons appealed, the Seafarers’ trustees agreed to provide $50,000 - the plan’s limit for a catastrophic situation, Smith said.

The Seafarers’ union trust, as the insurance plan is classified, is regulated by the U.S. Department of Labor.

The federal government doesn’t require that certain medical procedures be covered. Responsibility lies with the union and the employer, which negotiated the benefits, said Jean Ackerman, a Labor Department spokeswoman.

She also noted that policyholders are free to buy extra insurance coverage.

The Manipons’ situation dismayed Paul Menzel, professor of philosophy at Pacific Lutheran University and a specialist in medical ethics.

Menzel said that years ago, insurance plans excluded transplants because they weren’t successful often enough for the cost. That’s no longer true.

“Admittedly, they are expensive,” Menzel said. “But that doesn’t mean they’re a bad bargain if the chances of success are high enough and the length of life is long enough.”

Menzel agreed with Klarnet that divorce may be an answer, but he’s horrified by the statement it makes.

“Is it worth getting divorced if it’s the only way to save your life?” he asked. “Tragically, probably yes.

“But look at what it says about a society that says it supports family values. Their action should be a wake-up call for society.”