Name Nelene Fox | Died April 22, 1993 | |
Mark Hiepler ABC News - Bad Faith Insurance Verdict
Nelene Hiepler Fox (January 9, 1953 - April 22, 1993) was a California woman diagnosed with advanced breast cancer. She requested her HMO to pay for High-Dose Chemotherapy and Bone Marrow Transplant (HDC/BMT) to treat her cancer. Her health maintenance organization, Health Net, declined her request, stating this therapy was an unproven, experimental therapy. She ultimately received her BMT after raising $212,000, but died eight months later, aged 40.
Contents
Her estate sued and received $5 million due to the denial. Subsequent research proved that HDC/BMT was a harmful treatment for breast cancer patients, and it is no longer used.
Lawsuit
Her estate brought suit against Health Net, and won a judgment for $89 million against Health Net, including $12.1 for bad faith and reckless infliction of emotional distress, and $77 million in punitive damages. Jim Fox and the estate of Nelene Fox v. Health Net is considered a watershed case in that most health insurers subsequently began approving HDC/BMT for advanced breast cancer. This judgment was subsequently negotiated down to $5 million.
Consequences
By September 1994, the Federal Employees Health Benefits Program, which covers employees of the United States' federal government, began requiring all of its health plans to pay for HDC/BMT for advanced breast cancer. The State of California subsequently passed a law requiring health insurance to pay for HDC/BMT.
Subsequent research reportedly shows that HDC/BMT for advanced breast cancer does not extend life, worsens quality of life, increases the number of days hospitalized, and costs an additional $55,000
Opinion
Some researchers claim that the politicization of HDC/BMT for breast cancer made it more difficult to recruit women into randomized trials to evaluate its efficacy, as most women did not wish to take the chance of being randomized into the conventional treatment arms of such studies.