Hematopoeitic stem cells. Credit: ustas/Adobe Stock
A California resident with multiple sclerosis and her mother are suing Anthem Blue Cross Life and Health Insurance Company over the company's refusal to cover an autologous hematopoietic stem cell transplantation treatment.
The patient, Callie McKay, and her mother, Bethany McKay, contend that Anthem Blue's own medical policy statement shows that the company believes a stem cell transplant may be medically necessary for patients with the kind of aggressive, progressive, multiple sclerosis that Callie McKay has. Studies have suggested that the transplants could stop or even reverse the effects of multiple sclerosis for some patients.
Anthem Blue, a unit of Elevance Health, has repeatedly blocked Callie McKay from getting the transplant by taking steps such as denying her coverage for the kind of medication, such as natalizumab, that she must take before she can be considered a candidate for a stem cell transplant, according to a complaint the McKays filed earlier this month in a state court in Los Angeles County, California.
Attorneys for Anthem have not yet appeared in court, and representatives for Elevance were not immediately available to comment on the case.
Multiple sclerosis is a condition in which an individual's immune system attacks the myelin layer that normally covers and protects the nerves.
Callie McKay's age was not available.
The cost of typical stem cell autologous stem cell transplants, which involve the use of cells from a patient's own body, runs from $15,000 to $75,000, according to DVC Stem.
What it means: The McKay case involves an individual health insurance policy, not an employer-sponsored health plan.
But the case could end up having an impact on how the California courts see all suits for insurance coverage for stem cell transplant suits, because review of the Law.com lawsuit complaint database and the federal government's GovInfo federal court opinion database suggests that recent court cases involving patients' suing commercial health insurers or employer health plans over coverage for stem cell transplants in connection with multiple sclerosis have been uncommon.
The McKay case could also have a direct effect on stem cell transplant benefits at fully insured group health plans in California.
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