HEALTH COVERAGE NEEDS COMMON SENSE

Health is something people often taken for granted -- until the unthinkable strikes. Gary Farmer takes each day at a time as he waits for a lung transplant. The 47-year-old Cape Girardeau man suffers from a rare lung disorder. He is one of only about 500 people nationwide diagnosed with the disease.

Farmer has found himself at odds with his insurance company -- Blue Cross Blue Shield of Missouri's HealthNet Blue -- over out-of-network coverage. Managed care plays an important role in keeping health-care costs down and extending services to more people. But these companies also need to exercise common sense and flexibility about out-of-network treatments.

HealthNet Blue has agreed to pay for the lung transplant if the operation is done in the network at St. Louis University Medical Center, but there is a two-year waiting list.

The cost of the operation would be cheaper and the waiting list is much shorter at Vanderbilt Hospital in Nashville. But that hospital won't put the Cape Girardeau man on the waiting list until he is bedridden. Farmer worries that may be too late. His St. Louis doctor said Farmer won't live the two years without the transplant, although a Vanderbilt doctor said he could. His family finds frustration in the rules and regulations and differing medical opinions.

Farmer isn't alone in his wait for a lung. Nationwide, nearly 2,500 people are waiting for lung transplants. Lungs are the hardest organ to recover for transplant, because the organ typically fills up with fluids after a person dies.

HealthNet Blue won't decide if it will pay for an out-of-network lung transplant until a hospital agrees to put him on the waiting list. That's understandable. But if Farmer finds a hospital with a shorter waiting list and lower costs outside network, Blue Cross should seriously consider the exception.

Insurance companies play an important watchdog role in keeping medical costs down. While maintaining the insurance network is important, it shouldn't dominate these life-and-death decisions. Medical decisions should rest with the doctors, with the health and welfare of the patient taking the forefront.