TO LIVE AND DIE IN SCOTTSDALE

YVONNE CAMENOS WASN'T RICH OR FAMOUS. BUT THOSE WHO WITNESSED HER FOUR-YEAR BATTLE AGAINST OVARIAN CANCER WON'T EVER FORGET HER.

The chemotherapy is so potent that nearly one out of ten Americans dies during the treatment. But for those in alternating periods of cancer remission and recurrence, the risk often is worth it.

"I was told that this might cure me--the uncurable one--once and for all," Yvonne said. "That was the best music I've ever heard. My question was, would our insurance company pay for it?"
The answer was a resounding no.
Central Reserve had paid Yvonne's medical bills--more than $25,000--without a significant glitch in 1991-92. But the insurer balked in July 1993 after a City of Hope doctor indicated Yvonne's lone hope was a marrow transplant.

"We have been advised," Central Reserve Life's Leslie J. Moore wrote, "that the use of high-dose chemotherapy with . . . bone marrow transplant for the treatment of ovarian cancer is considered experimental in nature."
Insurance companies pay for traditional chemotherapy without blinking an eye. But marrow transplantation is very expensive, about $225,000 in Yvonne's case.

"The jury is still out on [marrow transplants]," says John Cova, a consultant for the Health Insurance Association of America. "It does a disservice to the individuals who are covered because they receive unproven treatment."
Bone marrow transplants are no panacea. But Cova should try telling that to the thousands whose lives have been extended by successful treatments.

The procedure has entered the health-care mainstream, and many insurers have become hesitant about fighting marrow transplant issues in court.

A turning point came in 1992, when a California jury awarded $89 million to the family of a breast-cancer victim whose insurer had refused to pay for a marrow transplant. A scanning of similar cases indicates the dollar amount in the California case was extraordinary, but not the verdict.

"Bone marrow transplants are not much of an issue anymore," says Gary Tysch, an attorney for the City of Hope. "But that apparently hasn't kicked in with some companies, such as Central Life. They think that just by calling something, quote, experimental, that they can avoid their responsibilities."
Yvonne Camenos in the summer of 1993 resolved to go to the City of Hope, with or without her insurer's authorization.

"It's like a computer told Central Life, 'That woman should be dead by now,'" she said. "But, surprise, surprise, I'm still here. They force you to tell them, 'Go screw yourselves. I'm going to the City if they'll have me.'"
The City of Hope's plan in situations such as Yvonne's is simple: In August 1993, the staff welcomed her with open arms.

"A person who is battling cancer should not have to battle the insurance company, too," Tysch says. "Our position is, we treat the patient no matter what the insurance company says. My job is to go after the insurance company to pay up afterward."
(A City of Hope lawsuit against Central Reserve is pending in Phoenix. In court papers, attorneys for Central Reserve claim Yvonne's transplant "was not necessary to the care and treatment of her illness. . . . Her treatment was not a generally accepted medical practice in the U.S. for her illness.")

Doctors at the City of Hope removed and stored Yvonne's bone marrow as scheduled. Then came agonizing days of chemotherapy.

"They tell you they're going to take you to the edge of death and back," she said, "and they aren't kidding. You do want to die a lot of the time, but you just don't."
Actually, Yvonne did almost die of complications during her treatments. Because of the extent of her prior chemotherapy, she lacked an adequate amount of bone marrow. Two siblings and her daughter Jennifer donated lifesaving blood platelets.

Slowly, Yvonne edged back to life.
Yvonne's neighbor at the City of Hope was a breast-cancer patient named Hattie Anderson. The Cerritos, California, woman says she was awed at Yvonne's attitude.

"She picked up the spirits of everyone on our unit," says Anderson, whose cancer is in remission. "She'd tell someone, 'Hey, you, don't be afraid. You're alive and you're gonna get better.' And she was about the sickest of all of us. I would go into her room and rub her feet to try to ease her pain. She just got into my heart and stayed there."
Yvonne wanted to go home after more than a month at the City of Hope. The hospital discharged her in early October 1993. No one knew if the transplant would work, but Jim Camenos expressed the couple's thanks in a letter.

"If there is a place called heaven," he wrote the nurses and staff of the City of Hope's Unit 6, "then surely you each have a spot reserved in your name, as you are all truly angels."
But the angels could not work a miracle for Yvonne Camenos. She expected the worst after a bad CA-125 test in early 1994. A fourth cancer surgery confirmed her suspicions.

"I knew I could only take so much," she said. "They told me my tumors were back and--this time--I had less than a year left. But I didn't think my kids were quite ready to be without me. So I didn't give in."

Those closest to Yvonne could not fathom how she was coping.
"It was hard to get inside her head and know what she was really thinking," says daughter Pauline, who again returned home over her mother's objections.

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