It's wrong to say that Bob Iritano is fighting for his life; he knows he's lost that battle. What he's fighting for is time.
You wouldn't know it to look at him, but Iritano, 50, has terminal cancer. It's not a question of whether he's going to die. The only question is when, and how much longer he'll be with his family.
Iritano, understandably, wants all the time he can get -- many years, if possible. His health insurer, he believes, has a different time frame in mind.
"My best guess is that they want me dead as soon as possible," he said matter-of-factly as we spoke at the dining room table of his Westlake Village home. "They know that the premiums I pay will never cover how much they'll spend on me."
Iritano glanced at his wife, Karen, 52, who nodded her agreement.
The Iritanos aren't strangers to this cratered landscape. He's an insurance broker, dealing in commercial policies for businesses. She's a registered nurse with a background in oncology.
As we chatted, one of their kids approached the table to complain that his big brother was hogging the Xbox game machine. "Give us a few minutes," Karen replied softly. The 7-year-old frowned at the unfairness of it all and left the room.
The Iritanos contacted me after their insurer, Health Net, refused to pay for a procedure this month that it had willingly covered only six months earlier. The company had changed its medical guidelines, a rep told them. The procedure was now deemed experimental.
"How can they do that?" Iritano wanted to know. "How can they change the rules just like that?"
Not surprisingly, a little media attention would get Health Net to change its mind yet again, but only on a temporary basis. Longer term, Iritano still has a fight on his hands.
He arrived at Los Robles Hospital & Medical Center in Thousand Oaks on Feb. 10 to once again bombard malignant tumors on his liver with microwaves.
But Iritano said that as he stood in the hospital room in his surgical gown, surrounded by doctors, nurses and an anesthesiologist, a Health Net rep informed him by phone that the insurer had changed its mind about the treatment.
If Iritano went ahead with the procedure, the rep said, he'd be on the hook for the full $20,000 cost.
"I was pretty crushed," Iritano recalled. "You have to mentally get prepared for these kinds of procedures. To have it pulled out from under you. . . ."
Iritano's doctor rescheduled the procedure several times, and each time Iritano's appeal of Health Net's decision was denied.
"It's getting worse every day," he said of his condition. "The pain keeps growing."
As it happened, the day we got together last week was Iritano's birthday. He'd just received word from Health Net that because he'd reached the half-century mark, his insurance premium would rise from almost $1,800 a month to more than $2,500 -- a roughly 40% increase.
What price do you put on a life, or even just a few extra years of life?
The Iritanos have been married 11 years. They have four kids ages 7 to 12. The youngest are twins.
"It's not like I'm on my deathbed," Iritano said, his blue eyes flashing. "I work. I go to my kids' baseball games."
"Just look at him," Karen agreed. "Does he look like he's dying?"
He doesn't. Aside from a slight limp resulting in part from having a tumor surgically removed from his spine, he seems fine. If you didn't know about the cancer, you wouldn't realize that time was slipping away.
Iritano was diagnosed with Stage IV metastatic sarcoma in February 2007. He underwent chemotherapy shortly afterward, but an allergic reaction almost killed him. Iritano was hospitalized for two weeks.
When tumors appeared on Iritano's liver last August, his doctor tried a procedure called radio frequency ablation -- tightly targeted microwaves that zap the lesions.
Studies at the University of Texas and Royal Marsden Hospital in London have found this to be an effective treatment for such tumors. Health Net covered the procedure without question in August, and Iritano's tumors were eliminated.
"This procedure is not experimental and it's not investigational," said Dr. Ilya Lekht, Iritano's radiologist. "It's been clearly shown in literature to be effective. We've been doing it since the 1990s."
Health Net's denial letter this month said that "a better choice for additional therapy would be chemotherapy" -- a treatment that Iritano's medical history suggests would almost certainly be fatal.
I contacted Health Net to discuss Iritano's case. A few days after I told the company I'd be writing about the matter, Health Net sent Iritano a letter saying he could have the procedure after all.
The company said it hadn't changed its mind about the investigational nature of the treatment.
But it said that "in light of rapid disease progression, Health Net will cover an additional radio frequency ablation treatment to the liver as an administrative exception."