Canary in a Coal Mine

The drug that could help Shelley Rozolsky is too experimental for her county-sponsored health plan

That could change, notes Gadinski. The insurance giant has an appeals process that includes review of all the available data by an independent immunologist. Should such a doctor approve immunoglobulin for treatment of urticaria, Humana might agree to pay. But such things take time -- as many as 30 days -- for an answer.

The bottom line: "My point would be, for consumers who are considering making a switch, they need to look at a much broader picture than just what it costs," says Gadinski.

So Rozolsky finds herself stuck in insurance purgatory. An effective treatment for her condition exists, and her doctor is willing to administer it to her. But she has no way to pay for it. Eventually she may be forced to choose between tuition and a medicine that would allow her to live a normal life. "That's something I don't really even want to think about," she says.

If the insurance company relents, Rozolsky may be something of a canary in a coal mine. According to the available research, says Moreno, as much as 40 percent of all urticaria cases could be autoimmune in origin. If that proves to be true, it could answer a lot of questions. "Urticaria is one of those conditions in which you can do a million-dollar workup and you don't find anything that points to the cause," Moreno says. "You may still have the problem 20 years after diagnosis."

For now Rozolsky has to wait to find out whether or not she'll get another round of immunoglobulin. She's filed a complaint with Humana, and Moreno has sent in all the research he can get his hands on.

It's all going into her book someday. "I don't trust primary-care physicians," she says with a smile, though she's dead serious. "They are looking to save money, and no one saves money at my expense."

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