Bloodwork was supposed to be the last step in Isela’s application for life insurance. But when she arrived at the lab, her appointment had been canceled.

“That was my first warning,” Isela says. She contacted her insurance agent and was told her application was denied because something on her medication list indicated that Isela uses drugs. Isela, a registered nurse who works in an addiction treatment program at Boston Medical Center, scanned her med list. It showed a prescription for the opioid-reversal drug naloxone — brand name Narcan.

“But I’m a nurse, I use it to help people,” Isela remembers telling her agent. “If there is an overdose, I could save their life.”

That’s a message public health leaders aim to spread far and wide. “BE PREPARED. GET NALOXONE. SAVE A LIFE,” was the message at the top of a summary advisory from the U.S. surgeon general in April.

But some life insurers consider the use of prescription drugs when reviewing policy applicants. And it can be difficult, some say, to tell the difference between someone who carries naloxone to save others and someone who carries naloxone because they are at risk for an overdose.

Primerica is the insurer Isela says turned her down. (NPR has agreed to use just Isela’s first name because she is worried about how this story might affect her ongoing ability to get life insurance.) The company says it can’t discuss individual cases. But in a prepared statement, Primerica notes that naloxone has become increasingly available over the counter.

“Now, if a life insurance applicant has a prescription for naloxone, we request more information about its intended use as part of our underwriting process,” says Keith Hancock, the vice president for corporate communications. “Primerica is supportive of efforts to help turn the tide on the national opioid epidemic.”

After Primerica turned her down, Isela applied to a second life insurer and was again denied coverage. But the second company told her it might reconsider if she obtained a letter from her doctor explaining why she needs naloxone. So, Isela did contact her primary care physician — and then realized that her doctor had not prescribed the drug.

Isela had bought naloxone at a pharmacy. To help reduce overdose deaths, Massachusetts and many other states have established a standing order for naloxone — one prescription that works for everybody. Isela couldn’t just give her insurer that statewide prescription; she had to find the doctor who signed it. As it happens, that physician — Dr. Alex Walley — also works at Boston Medical Center.

Walley is an associate professor of medicine at Boston University; he also works in addiction medicine at Boston Medical Center and is the medical director for the Opioid Overdose Prevention Pilot Program at the Massachusetts Department of Public Health.

“We want naloxone to be available to a wide group of people — people who have an opioid use disorder themselves, but also [those in] their social networks and other people in a position to rescue them,” Walley says.

He says he’s written a half dozen letters for other BMC employees denied life or disability insurance because of naloxone, and that troubles him.

“My biggest concern is that people will be discouraged by this from going to get a naloxone rescue kit at the pharmacy,” Walley says. “So this has been frustrating.”

The life insurance hassle — and threat of being turned to down — has discouraged Isela and some of her fellow nurses. She is not carrying a naloxone kit outside the hospital right now because she doesn’t want it to show up on her active medication list until the life insurance problem is sorted out.

“So if something were to happen on the street, I don’t have one — just because I didn’t want another conflict,” Isela said.

BMC has alerted the state’s Division of Insurance, which has said in a written response that it is reviewing the cases and drafting guidelines for “the reasonable use of drug history information in determining whether to issue a life insurance policy.”

But Isela isn’t a drug user. And yet, she is being penalized as if she were.

Michael Botticelli, who runs the Grayken Center for Addiction Medicine at BMC, says friends and family members of patients with an addiction must be able to carry naloxone without fear that doing so will send them to the insurance reject pile.

“It’s incumbent on all of us to make sure that we try to kind of nip this in the bud,” he says, “before it is any more wide-scale.”

Botticelli says increased access to naloxone across Massachusetts is one of the main reasons overdose deaths are down in the state. The most recent state report shows 20 fewer fatalities this year compared to last.

Botticelli relayed his concerns in a letter to Dr. Jerome Adams, the U.S. surgeon general, who says he contacted the National Association of Insurance Commissioners. That group says it has not heard of any cases of life insurance applicants being denied because they purchased naloxone.

Adams says it’s good to, as Botticelli suggests, nip the problem in the bud.

“Naloxone saves lives,” Adams says, “and it is important that all Americans know about the vital role bystanders can play in preventing opioid overdose deaths when equipped with this lifesaving medication.”

Isela says the second company that rejected her has agreed to let her reapply, in light of Walley’s letter stating that she carries the drug so that she can reverse an overdose. Isela is in the process of reapplying.

This story is part of a reporting partnership with NPR, WBUR and Kaiser Health News.

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Tim Green first noticed the symptoms about five years ago.

The former NFL player, whose strength was a job requirement, suddenly found his hands weren’t strong enough to use a nail clipper. His words didn’t come out as fast as he was thinking them.

“I’m a strange guy,” Tim says. “I get something in my head and I can just run with it. I was really afraid I had ALS. But there was enough doubt that I said, ‘Alright, I don’t. Let’s not talk about it. Let’s not do anything.’ “

Denying pain and injury had been a survival strategy in football.

“I was well trained in that verse,” he says.

But a diagnosis in 2016 made denial impossible. Doctors confirmed that Tim, also a former NPR commentator, had ALS, known as Lou Gehrig’s disease. The degenerative illness attacks the body’s motor nerve cells, weakening muscles in the arms and legs as well as the muscles that control speech, swallowing and breathing.

Tim tried to keep it private — he didn’t want people feeling sorry for him.

But he says, “I got to a point where I couldn’t hide it anymore.”

So Tim went on 60 Minutes and revealed his illness.

“What we said is, you either write your own history or someone’s going to write it for you,” says his 24-year-old son, Troy Green.

When one isn’t enough

I was one of Tim Green’s producers for his Morning Edition commentaries back in the 1990s. We went to dinner once when he was in Washington, D.C., for a game — his Atlanta Falcons were playing Washington. Tim had a huge plate of pasta. When we finished, the waiter came over and asked, “Anything else?” Tim pointed to his clean plate and said, “Yeah. Let’s do it again.”

That was him. One entree wasn’t enough. One high-profile career wasn’t enough — he’s also a prolific author, has a law degree and works for two firms.

And ultimately, it wasn’t enough for Tim to deal with ALS in silence. Last month, in conjunction with his 60 Minutes appearance, Tim helped launch a fundraising website, Tackle ALS.

Writing his own story

I recently visited Tim at his lakeside home in upstate New York, in the village of Skaneateles.

We sat down in a room with a huge picture window that normally offers a gorgeous view of Skaneateles Lake. On the day I visited, all you could see was driving snow. Troy Green sat next to his dad — Tim’s speech is slow and raspy, and sometimes Troy helps repeat or reinforce Tim’s words. During our talk, a tube connected to a port in Tim’s chest provided an infusion of Radicava. Last year, the FDA approved the new drug, which has been shown to slow the progress of what’s currently a fatal disease.

The history Troy encouraged Tim to write is positive and hopeful. They stress that ALS can be cured, it’s just underfunded.

The history certainly includes family. Tim and his wife Illyssa have been married for 29 years. They have five kids — all with first names starting with “T” — that’s Illyssa’s doing, Tim says. And the family is incredibly close. Literally.

“My brother lives on the same lane as us. I’m their neighbor,” Troy says, adding, “My little sister’s at school, my little brother lives here and then my older sister lives the furthest away. She’s about a three-minute drive.”

“We’re going to reel her in,” Tim laughs.

Football, a complicated love

Of course, any Tim Green history has to include football.

For better and worse.

Tim believes football gave him the disease. His eight years in the NFL in the 1980s and 90s, as a defensive lineman and linebacker, were before protective rule changes and concussion protocols.

There were “countless” head collisions, Tim says. I mention that he had decades of those collisions, from an early age through the NFL.

“But in the NFL,” he says, “the violence and the impacts are extraordinary. Every day.”

Troy adds, “when [Tim] played, practices were worse than the games. Because in the game, you typically would see 45 to 65 plays. In practice, you could run 100, 200 by the time you’re done with drills.”

Researchers say repetitive head blows may play a part in causing ALS. The recent NFL concussion settlement acknowledged a link by including payouts to former players with the disease, including Tim.

His Morning Edition commentaries regularly took listeners inside the violent game. In 1992, Tim wrote one about a teammate, former Atlanta defensive end Rick Bryan, who’d had enough of the physical toll and was retiring.

The piece ended with this:

“Back at the locker room, I checked my protective neck padding and pumped some extra air into the padding of my helmet. Like a gypsy gazing into a crystal ball, I looked at my own distorted reflection in the glossy black surface of my helmet. The smile let me know I was glad to be there, but there was nothing I could see that told me how long it would last.”

Tim could articulate what many players couldn’t. Why, I asked him, with his insights, would he play a sport that had the potential to do permanent damage?

Tim says as a kid, he had two passions: writing and football. From the earliest age, he says, he worked incredibly hard to succeed at both, and he did.

“I was just impassioned,” he says. “That’s what I wanted, and that’s what I got.”

“If [this disease] is part of the bargain, I don’t know,” he continues. But back then, he says, he had “no idea” of the potential long-term damage of football. “So the temporary pain and discomfort, I knew that was worth it. Some pain in the future with my back, neck, knees, I knew that was worth it.”

“Can I say getting ALS was worth it? I don’t know. I don’t know.”

His ambivalence illustrates Tim’s profound and complicated love for the game. Still. He says it gave him the disease. But it also taught him so many life lessons growing up. It allowed him to vent anger and violence in an acceptable way.

“I’m not indicting football or the NFL,” he says.

He passed on his love — his two oldest sons played football. His 12-year-old, Ty, plays now. And it has split the close-knit Greens. Illyssa doesn’t like it. Tim says he wants Ty to play if he wants to.

Tim and Troy say the game now is different than it was. It’s much safer with less contact in practice. Both of them coached Ty’s junior team.

“We trained [so in] every tackling drill your head’s out of the play,” Troy says. “In practice we would penalize our players if they had their head in the drill. We really just encouraged the modern day football, not the 1980s edition.”

Still, football is inherently dangerous, and so far Ty wants to play.

“I don’t want to wrap him up in a bubble,” says Tim, “because where do you stop?”

But there’s a deeper, more complex reason behind Tim’s support. Troy says his dad doesn’t want the illness to be a burden on anyone. So Tim doesn’t want Ty not to play just because the game hurt him.

Translating science into treatment

“I do want to point out that most people who play football don’t develop ALS.”

So says Dr. Merit Cudkowicz, who treats Tim’s disease. Cudkowicz has researched ALS for nearly 25 years. She thinks football probably is a factor that led to his illness, but not the only one. The studies so far haven’t established a direct cause and effect.

“And that’s why we think there’s something else,” Cudkowicz says. “It’s a combination perhaps in someone’s immune system or something in their genetics that makes it more likely that if you also hit your head repetitively that you might come down with the disease.”

Cudkowicz directs the Healey Center for ALS at Massachusetts General Hospital in Boston. She says Tim’s and other prominent people’s involvement and publicity present a great opportunity, as a follow up to the viral ice bucket challenges that raised money for ALS a few years ago.

“Absolutely I think this is a huge next step,” Cudkowicz says. “The ice bucket challenge came at the right time. The science was exploding, but there were no resources for it. And suddenly there’s this $220 million resource for ALS, and it fed this great science and drew in all these new people and new companies for the field.”

“But there’s still a [funding] gap in getting that great science to patients. And that’s where Tim’s Tackle ALS initiative and the Healey Center are going to partner and hopefully with many other groups, translate that great science into treatment for people.”

‘If you have a good life, it’s never long enough’

Later, on the day I visited, Tim sat down at a desk in a large wood-paneled den, indulging his other passion in life — writing.

He can’t type, so he has a sensor on his glasses that highlights letters. Then he clicks a mouse and the letters show up on his laptop screen. He’s working on a kid’s baseball book. It’s a third collaboration with former New York Yankees star Derek Jeter, and Tim says they both provide specific areas of expertise. Jeter brings baseball realism to the book; Tim draws on his many years of being surrounded by young people. Disgusting young people, he laughs.

“These are kids 10 to 14 years old. Tweens,” he says. “They think vomit is funny. [So] somebody has to throw up [in the book], and it’s best when they throw up on someone.”

“Writing [these scenes] is easy. It’s convincing Derek to keep them is where I earn my money.”

On cue, Troy looks up from his phone and makes an announcement.

“Just got an email that Jeter, and [his] Turn 2 Foundation donated $10,000 [to Tackle ALS]. His ears are ringing,” Troy says, laughing. “He heard about the vomit scenes!”

Tim says the fundraising is a chance to help others. He says he’s one of the luckier people with the disease. It’s relatively slow-moving.

I ask Tim what keeps him positive through this time. He answers by recounting a period 12 years ago, when Illyssa was diagnosed with cancer.

“She was out of her mind,” Tim says, “and I remember saying to her, ‘You’ve got great doctors, we’re gonna beat this and do everything we can. But in the meantime, I don’t want you to wallow in fear and anxiety and misery.’ I said, ‘because we have a very good life and if you have a good life … and a lot of people do, maybe they don’t realize it, but they do … but if you have a good life, it’s never long enough. We all know it’s finite.’ “

“So whenever the end point is, I ask to be strong enough to maintain that positive attitude no matter what the challenges are.”

Today, Illyssa is cancer-free. And it’s Tim trying to live by his own advice.

As I leave, I stop to look at two large sculptures outside their house. One is of five kids, playing. The other is a lone figure. A helmeted football player, running and catching a pass over the shoulder. Tim says it’s an homage to the game that let him “buy this amazing property and build a comfortable home.”

A home, and family, that now mean even more than they have all along.

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