Anthem Blue Cross: Treatment Not ‘Medical Necessity’ For Man With Dozens Of Tumors

Anthem Blue Cross is making what could be the last days of a California dad’s life even more difficult, as his family does all it can to save him. Jefferey Rusch is Sonoma County man who just wants some more time with his four-year-old son and his wife, Zoe Keating, a professional musician.

Sadly, he is in a race against time. After suffering from what his wife calls “a mysterious illness” for months, Rusch went in for MRI and CT scans on May 13 and 15. Using the imagery, doctors found 20 cancerous tumors in his brain, a “softball size” tumor in his lungs and even more cancer in his bones and his liver.

As soon as he got this terrible diagnosis, Rusch went in for treatment right away.

“On our way home from the imaging center our primary care doc called and told us to turn around and get to the hospital right away,” Zoe Keating wrote later on her blog. “My husband was admitted and they promptly removed more than a pint of fluid from his lungs, which helped him breathe better. We were there for six days while they performed a bronchoscopy, did more scans, gave him drugs to stop his brain from swelling and administered emergency chemo.”

A week later, Rusch and Keating got a letter in the mail from their insurance company, Anthem Blue Cross — the same insurance company they signed up with in 2008. Since then have shelled out, they say, more than $100,000 in premium payments to Anthem Blue Cross.

Here is what the letter from Anthem Blue Cross said, as quoted on Keating’s 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 company wrote. “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.”

“It’s like an attack on my family. It feels that way,” said Rusch, who is battling the deadly cancer, and now must battle Anthem Blue Cross as well.

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

As Keating pointed out on her blog, Joseph Swedish, the CEO of the Anthem Blue Cross parent company Wellpoint, was paid $17 million in salary and other compensation last year.

“Now you know how they can afford to pay him,” said Keating on her blog.

Anthem Blue Cross did not comment to the media about the case, citing privacy restrictions.

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