THE WAITING GAME; INSURANCE COMPANY DEBATES LIFE AND DEATH DECISION FOR POTENTIAL TRANSPLANT PATIENT

Gary Farmer is trapped in a deadly waiting game for a lung transplant.

Whether the 47-year-old Cape Girardeau man lives or dies may depend on Blue Cross and Blue Shield of Missouri, the huge health insurance company based in St. Louis.

At issue is whether Farmer -- who has a rare lung disorder -- must have the transplant done at St. Louis University Medical Center, where there is two-year waiting list for lung transplants.

For Farmer, a two-year wait could be a death sentence. Farmer said his St. Louis doctor has told him that he won't live two years without a transplant.

Farmer wants to go to Vanderbilt University Medical Center in Nashville. He said he could receive a transplant within possibly as little as two months at that hospital.

He said a single-lung transplant would cost $250,000 at the St. Louis hospital. At Vanderbilt University Medical Center, he would receive a pair of lungs and the transplant procedure would cost only $150,000 to $180,000, Farmer said.

But the Nashville hospital is outside of the HealthNet Blue managed care network.

In a July 3 letter to Farmer, Blue Cross' associate medical director, Dr. Michael Rominger, said the insurance company wouldn't cover the procedure at the Nashville hospital because the facility isn't part of the HealthNet Blue network.

HealthNet Blue serves the Cape Girardeau region.

Farmer appealed the insurance company's decision.

On Saturday, he was still waiting for a decision.

Blue Cross officials said they were still considering the appeal.

"We are aggressively exploring every option," said Deborah Wiethop, a Blue Cross spokeswoman in St. Louis.

Wiethop said Blue Cross hopes to make a decision in the next several days.

Farmer's wife, Nancy, said that under managed care, insurance companies are making life-and-death decisions.

"They are playing God," she said.

Farmer suffers from primary pulmonary hypertension, a rare lung disorder. He said he is one of only about 500 people nationwide who currently have been diagnosed with the disease.

Doctors don't know what causes the disease, he said.

The disease leads to above-normal pressure in the pulmonary artery, the blood vessel that leads from the heart to the lungs.

Symptoms can include shortness of breath, fatigue, dizzy spells and fainting.

In Farmer's case, he suffers from shortness of breath and fatigue. He also has memory lapses.

The disease can damage the heart.

Farmer wears a portable pump around his waist, which dispenses medicine through a tube into his body. The medicine works to relax the artery and lower the pressure.

The medicine is expensive. Farmer said Blue Cross has spent $100,000 so far this year to pay for his medication and doctors' bills.

The Farmers are spending a lot of their own money too. Gary Farmer estimated they spend about $300 to $400 a month on medicine.

Even if he receives a transplant, there would be continuing medical bills.

Farmer said he would have to take anti-rejection drugs, which could cost about $20,000 a year.

Farmer said the medicine causes severe jaw and leg pains. His face and hands have a reddish appearance, another side effect from the medicine.

He also has suffered serious infections. "We have been on IV antibiotics at home three times in the last two months," said Nancy Farmer.

Gary Farmer said he probably wouldn't have survived this long without his wife's assistance.

Nancy Farmer is a registered nurse and branch manager of American Home Patient, a company that provides in-home medical equipment and IV treatments.

Without the medicine, Farmer said, he could die within a couple of hours. On bad days, he can walk only a short distance without getting winded.

"The medication is only good for 24 hours," he said. He then has to mix up another solution of the medicine.

Even with the medicine, Farmer said he would die without a lung transplant.

He and his wife have even contemplated getting a divorce in an effort to qualify for public assistance as a way to pay for the transplant.