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P is a forty-year-old pre-menopausal adult female. She is employed by Magnavox Electronic Systems which maintains a health plan administered by D. The plan is an 'employee welfare benefit plan' as defined in 29 U.S.C. § 1002(1). P was diagnosed as having breast cancer and underwent a modified radical mastectomy. The surgery disclosed heavy lymph node involvement with the breast cancer cells. After the removal of the tumor, she was treated with standard chemotherapy and radiation. Her oncologist recommended that she receive heavy-dose chemotherapy with an autologous bone marrow transplant (HDC/ABMT) and referred her to the Cleveland Clinic for this treatment. D advised P that the HDC/ABMT treatment was not a covered service under the plan. P was entitled to a hearing following the denial of a claim, and P did in fact appeal the denial of benefits and received a hearing before a committee selected by D. The committee recommended that even though d had met its obligations D should change its policy and authorize payment for the procedure because the treatment was reasonable for a patient of P's age. D refused to pay stating that it had 'lived up to its Contract obligations' under the 'clear and unambiguous language in the Contract.' P initiated this suit in the U.S. and sought summary judgment which was denied. P appealed.

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