Imagine that tonight you have to make a decision that affects how you feel and quite possibly if you live for the rest of your life.
One woman is facing that decision, but it’s an insurance company that’s making the decision for her.
Gina Wilhem has Multiple Sclerosis.
She also has the approval to participate in a clinical trial where she would receive stem cell replacement therapy.
Doctors have told her she would not be randomized and she would indeed receive the therapy.
But her insurance company, Common Ground Healthcare, will not cover the huge bill and now she has one day to decide what to do.
Gina Wilhelm was diagnosed with M.S. when she was 15 years old.
She’s had plenty of up and down days, but many more down days in recent years.
“Twitching, tremors, shaking, I get really hot where I have to put even ice packs on my feet,” Gina says. “I can’t really walk, I’ll have to use my walker.”
Gina has been on all kinds of medications to suppress her immune system, many that lose their effectiveness over time.
So she did some research and discovered the stem cell therapy program down at Northwestern Memorial in Chicago.
“She went right to the doctor and said,’This is my plan. This is what I want to do,” Gina’s boyfriend, Jason Froelich, says.
“She went to Chicago and got tested to make sure she’d be accepted, and she was accepted.”
“Then she stopped her medicine. She was off it for a month, and we hit a road block.”
Then because her insurance company, Common Ground Healthcare, denied her coverage.
As of Friday, she has to re-start the meds she’s taken before.
But those meds give her a good chance of developing a deadly brain disease.
A good chance, but not a sure thing.
“When it went to the insurance, the insurance said, ‘No you don’t need it, you’re not dying,'” she says.
That’s what Common Ground told Local 5 News in an email.
If Gina isn’t told by doctors she has less than 12 months to live, she’s not covered.
Gina filed an appeal to the decision, and that was dined, too. So she got the help of David Mair, a healthcare advocate from Soter Health in Minnesota.
He says the wording in the Common Ground certificate of coverage is not being interpreted correctly by the company.
“So we’re talking about the difference between the word ‘and’ and ‘or’ essentially,” Mair says. “That’s what Common Ground is hanging its hat on.”
Common Ground did not respond to questions about Gina’s case. And now, unless Gina can raise 125 thousand dollars on her Go Fund Me site, she’ll have to resume taking meds that could have deadly side effects.
If doesn’t take the meds,she can become paralyzed in the next few days.
That leaves her son and her boyfriend of 18 years scared about what’s going to happen next.
“You get those days where it’s knocking on your back door saying, ‘You’re not going anywhere because I’m right here behind you,'” Jason says. “And it just sucks. Because sometimes you wish you could just shut the door.”
Wisconsin Senator Ron Johnson and Governor Scott Walker have taken an interest in Gina Wilhelm’s case.
Senator Johnson is trying to get help in Washington.
Whether that help will arrive in the next day is doubtful.
Here is a link to Gina’s Go Fund Me page: https://www.gofundme.com/hsctforginalea