When doctors discovered a tumor on Brett Nyquist’s brain a few days before Christmas in 2014, the 32-year-old knew he was in for a tough time. What he didn’t expect was that his insurance company, Florida Blue, would deny coverage of the treatment recommended by his doctors at the Mayo Clinic.
According to an article in the Orlando Sentinel, Nyquist is suing Florida Blue, along with his employer, Publix, because he had to pay out of pocket for the treatment he needed to survive.
The recommended treatment, proton therapy, was approved by the FDA in 1988 and later approved for Medicare and Medicaid reimbursement as well, according to the article. It targets tumors more precisely, according to oncologists quoted in the article, which is important when the tumor is in a sensitive area – near your spinal cord, for example, or your brain, as Nyquist’s was.
While the treatment is typically more expensive than traditional radiation, it can lead to shorter hospital stays and fewer complications, doctors said. But Florida Blue refused to cover it.
“It was so discouraging,” Nyquist said. “To be dealing with cancer and then learn you’re not covered, it was hard to believe.”
Nyquist wants to be reimbursed for the $200,000 that he, his friends and family raised to pay for his treatment. A letter to the editor also ran in the newspaper highlighting this case.
“These insurance companies are getting away with murder,” Cheryl Kennedy of Orlando wrote. “They make it extremely difficult for patients to get the care they need, requiring more and more paperwork and prior authorizations from physicians for proven therapies that benefit patients. The maze of red tape that is needed to just speak to an individual who can make a decision on behalf of a patient in need of care is atrocious.”
She added: “I believe we are missing the boat on health-care reform by not holding these insurance companies and pharmacy benefits managers accountable. I would love to see a report on the millions of hours wasted and dollars spent on denial of therapies at the expense of the premium-paying patient and the physicians who order the treatments.”
We agree with Kennedy. Insurance companies should be held accountable when they try to dodge paying for needed health care. They must do the right thing – patients’ lives are at stake.