Man With Multiple Tumors in Brain, Lungs And Bones Can't Get Coverage

A California man battling numerous tumors in his body has been denied coverage for treatment by his insurance company. 

Doctors told Jeffrey Rusch earlier this month that an MRI had found 20 tumors in his brain. Two days later a C-T Scan revealed a large tumor in his lung and more in his liver and bones. Rusch was told he had to be hospitalized immediately.

“My husband was having a lot of difficulty breathing already, and he was getting a lot worse, so we went to the hospital and they admitted him immediately,” Rusch’s wife, Zoe Keating, told KPIX-TV

Once Rusch was admitted to the hospital, doctors removed fluid from his lungs, gave him steroids to reduce brain swelling and administered emergency chemotherapy. 

A few days later Keating was notified by Anthem Blue Cross that the company would not pay for the treatments stating that they were not “medically necessary.”

She posted an excerpt from the letter on her personal blog.

"Coverage for the requested service is denied because the service does not meet the criteria for ‘medical necessity’ under your description of benefits,” the letter states. “To assist our Medical Director in making this decision, we have put a process in place to send all information about the service to a clinical reviewer with appropriate credentials. Based on their opinion, we have determined that covered for the requested service is denied. Our Medical Reviewer Layma Jarjour MD has determined we cannot approve your hospital stay for cancer. We do not have enough facts to show that it was medically necessary."

Keating said she and her husband have been Anthem members since 2008 and estimates they have paid over $100,000 in premiums to the company.

“I would call saving my husband’s life medically necessary,” she said.

Anthem Blue Cross is owned by WellPoint and insures eight million people in the state of California, according to a recent article from the Huffington Post.

That article indicates that WellPoint is mounting a huge effort in the state to kill a voter referendum that would enable California’s insurance department authority to reject excessive rate hikes. WellPoint has reportedly spent $12.8 million to stop the initiative.

WellPoint’s CEO, Joseph R. Swedish, made $17 million in his first year on the job, according to Salary.com.

Representatives from Anthem said they were unable to comment on Rusch’s case without a signed medical release form.

Sources: KPIX-TV, Keating’s Blog, Huffington Post, Salary.com


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