Albert Lucas wouldn't want to be remembered for his cancer, but his wife, Linda, couldn't let his story go untold.

On his deathbed, Albert Lucas asked her whether things would have been different if he had received the doctor-recommended treatment for his cancer sooner.

"He wouldn't want anyone else to go through this," said Linda Lucas, of Cheyenne.

Albert Lucas died Dec. 21 after an almost two-year battle with cancer.

Linda Lucas said she spent more than four months battling to get their private insurance to approve a treatment doctors said her husband needed.

It's a battle she said she won too late.

It's a battle she said she never should have had to fight.

Linda Lucas and others are trying to make sure others in Wyoming don't have to wonder if things could have been different.

They have formed the Coalition for Wyoming Insurance Solutions for Healthcare, or C-WISH, to help solve problems with accessing insurance benefits.

After successfully lobbying to add coverage of clinical trials to the state's insurance code, Loretta Wolf, Wyoming director of the American Cancer Society, said she discovered other areas of insurance didn't seem to work either.

Greta Morrow, a cancer survivor and the face of the clinical trials legislation, said the state was missing some basic consumer protection laws when it came to health insurance.

These included mandating external reviews of denied coverage, eliminating discretionary clauses from policies, defining medical necessity in statute and improving case management.

"It's a table with four legs," said Morrow, of Cheyenne, who had to fight to get an external review after her insurance company denied coverage of a clinical trial her Houston doctor recommended. "We really want to try to get all four legs."

Wolf said these policies shouldn't increase premiums, because they haven't done so in other states.

Just as Carol Chapman began her fight with an insurance company and to save her husband's life, the coalition began.

She said her husband, Larry, has become the poster child of the coalition.

Larry Chapman was diagnosed with a brain tumor in August 2007. By January, he wasn't able to get out of bed and was admitted to a hospital in Denver.

Doctors mentioned hospice, and Carol Chapman prepared to bring her husband home to their ranch on Hat Six Road to die.

Doctors decided to give Larry Chapman a drug called Avastin, which is normally used to treat colon cancer and is known to help with this specific type of brain tumor. He began getting better, and by April he was walking around.

The couple is now back at home.

Their insurance company refused to cover the Avastin because the company said it was experimental. Carol Chapman said Avastin costs $8,400 every three weeks, and they pay it themselves.

After the insurance company denied them, Carol Chapman called the Wyoming Insurance Department for help.

"But because there are no laws, there was not a lot the state could do," she said.

Someone at the state agency told Carol Chapman to call Morrow and Wolf.

"The laws they are going after are the ones that would have protected us," Carol Chapman said.

Even though the insurance company did an external review, it took six weeks and was done by a doctor the insurance company chose. The case was denied.

The next review took two months to get back. This time the insurance company didn't deny it, but they still haven't approved it either.

Even though the brain tumor still affects his communication and speech sometimes, Larry Chapman can still express his anger.

"They're not paying bills," he said. "They're walking away. They owe us a gob of money."

Linda Lucas said she and her husband didn't know their policy - Albert Lucas paid into the same policy for 40 years - had a discretionary clause and the company could refuse coverage.

She knew a man in Colorado who had the same type of cancer Albert did, and doctors recommended the same treatment. After the Colorado man's claim was denied, it immediately went to external review because of Colorado's laws, and he had treatment paid for in three weeks.

Ken Vines, Wyoming insurance commissioner, said his staff has attended some of the coalition's meetings.

"I think it is good they are providing an input," Vines said. "It's good to make policy makers aware of these types of things."

The coalition has discussed its ideas with interested legislators, Wolf said. She said there are other states that have these consumer protection policies, and there are models the Legislature could use.

They hope to have proposed legislation ready for the 2009 general session.

"I think we will be advocates for access to care," Morrow said. "These will be big improvements, but it's not the end of the road."

Contact health reporter Allison Rupp at (307) 266-0534 or allison.rupp@trib.com.

What the group wants

These are four suggested actions the Coalition for Wyoming Insurance Solutions for Healthcare would like to see the Legislature deal with next session:

* Defining "medical necessity" in state law -- Without a definition, the decision of what's necessary may be left up to medical directors at insurance companies, said Greta Morrow, a cancer survivor and patient advocate from Cheyenne.

Defining it allows "the doctor and the patient to have more right in making decisions than the insurance company," she said.

Eighteen states have defined medical necessity in their statutes.

- When coverage is denied in Wyoming, insurance companies don't have to review claims if they don't want to, said Loretta Wolf, Wyoming director of the American Cancer Society.

* Mandating external review -

Even when they do offer a review process, it could take months and can be done by a doctor the insurance company chooses instead of a specialist, said Carol Chapman, whose husband has a brain tumor.

The coalition wants the Legislature to mandate this review process if there is a disagreement between patient and insurance company. It also wants this process be overseen by the Wyoming Insurance Commission or another outside entity.

The District of Columbia and 44 states mandate external reviews.

A discretionary clause is any provision in a policy that allows the carrier to determine eligibility or interpret the terms of the policy. Insurance companies can "pick and choose" what they want to cover, the coalition said.

* Eliminating discretionary clauses -

The coalition wants to ban discretionary clauses, as 12 other states have done.

- Case management is a coordinated process that provides effective services in complex cases.

* Improving case management -

Good case management helped Morrow get coverage for clinical trials when her claim was denied, but she said this doesn't happen often. Also, not all case managers are certified.

She wants the Legislature to mandate insurance case managers be certified and that they follow federal guidelines.

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