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.

"I can see her in the kitchen, waving her spatula, bald, saying, 'It's my cancer, and I'll deal with it my way.' My father was there for her, and us kids, too. But she also was alone, and that made me cry." As Yvonne hung on, she had more to think about than her cancer.

"Central Life decided to stop paying a lot of my bills," she explained. "We couldn't get them to say why, other than the costs were in excess of 'reasonable and customary' charges, whatever that means."
Yvonne's medical bills confirm her account. In 1994 alone, for example, Central Reserve failed to pay the Mayo Clinic and Scottsdale Memorial Hospital-North more than $14,000 in new bills.

The Camenoses tried to sort things out in letters and phone calls. But they couldn't get a specific response from Central Reserve's claims department.

Finally, the insurer sent Jim and Yvonne a form letter that stated its position. Without giving specifics, Central Reserve claimed that Mayo Clinic's charges for Yvonne's outpatient care were "unreasonable."

It signed its correspondence, "Sincerely, Your Team #1 Customer Service Representatives."

Doctors are loath to involve themselves in patient/insurer imbroglios. But John Camoriano in 1994 was moved to compose a "To Whom It May Concern" letter about the situation.

"Following [Yvonne's] transplant treatment in September 1993," he noted, "it appeared that her insurance company had a significant change in its behavior. Apparently, they have made efforts to deny her coverage and reduce her coverage. . . . We will continue to treat this patient in the manner we feel is most appropriate for her condition."
As an example, the doctor noted that Central Reserve was not paying for Yvonne's prescription of Neupogen, the drug that prevents infections always lurking in chemotherapy patients.

Without the Neupogen, Camoriano pointed out, Yvonne likely would face expensive treatment because of infection. One or two hospitalizations would exceed the cost of months of Neupogen supplies, he wrote.

The Camenoses sought help on other fronts. Jim wrote to several elected officials, including Senator John McCain and then-congresswoman Karan English. The politicians did nothing.

"Unfortunately," McCain responded on February 24, 1994, "your situation is in the jurisdiction of Central Reserve. Therefore, I have forwarded your letter to [company chairman and CEO] Mr. Fred Lick Jr. Jim, I do hope your situation can be resolved favorably."
It wasn't. On May 11, 1994, Jim Camenos opened a stunning letter from Central Reserve. The company announced it was canceling its coverage in three weeks:

"The insurance contract covering your group requires you to maintain coverage on 75 percent of your total eligible employees for insurance to continue. Our records indicate that your group no longer complies with this provision. Since you have not responded to our letter of April 7, your coverage will terminate on June 1, 1994."
The letter floored Jim and Yvonne. They insisted they'd never received the April 7 letter. Moreover, the insurance company was flat wrong about the 75 percent figure. The family business at the time had just three employees, Jim, Yvonne and a secretary. Each was covered by Central Reserve.

Jim sent an overnight letter in response that included documentation about his work force.

A few days passed without response from Central Reserve. Desperate, Jim contacted the state Department of Insurance.

A state investigator, S.O. Yaffi, called Central Reserve--and got through to someone. Central Reserve said it had reinstated the Camenoses' group policy.

But nobody from the insurance company had bothered to tell Jim and Yvonne. They accepted the information gladly, but warily, and with good reason.

The roller-coaster ride with Central Reserve continued. Some months, the insurer paid for Yvonne's care; other months, it again deemed similar treatments "unreasonable."

When she was up to it, Yvonne tried to concentrate on bookkeeping for Jim. She tried to lose herself in her favorite television shows on PBS and the A&E network. She prayed.

But the insurance woes threatened to consume her.
"This insurance stuff is really upsetting and scary," she said last October. "They've reinstated us, but they aren't paying all the bills. I have to continue the treatments to stay alive. And there's no end in sight."
Yvonne took a needed break from her chemo for several weeks before Christmas, gaining strength and about 13 pounds. Her hair grew back. Without fanfare, she passed the one-year anniversary of her "less than a year left" diagnosis.

But in late March, Yvonne became very ill after a rare night out, dining with family members. Her cancer had returned with a vengeance.

Yvonne's reaction would be different this time.
"I wish I didn't have this," she said from her bed, a few weeks after the diagnosis, "but I'm not going to wallow in self-pity. I think He's finally calling me, and I'm ready to go. I know my kids can make it without me now, even if they don't know it."
For almost four years, Yvonne Camenos had maintained her dignity in the face of her withering disease. Now, she prepared to die.

Yvonne broke the news of her decision to Jim, her family and her doctor. Dr. Camoriano understood her decision and told her so.

"At some point, the patient has to weigh the value of just living versus truly living," the doctor said a few days after speaking with Yvonne. "She's made the decision to embrace death and I applaud her for that."
A few months earlier, Camoriano had visited an ancient basilica on a trip to Italy. There, he'd lighted a candle and offered a prayer for Yvonne.

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