Insurance Company Denies Coverage for Life-Saving Medication Multiple Times
Broken Arrow, Okla. — A local woman is fighting an uphill battle against Blue Cross Blue Shield of Oklahoma after the insurer repeatedly denied coverage for medication essential to her survival and mobility. Elizabeth Early, a principal at Broken Arrow Schools, suffers from chronic inflammatory demyelinating polyneuropathy (CIDP), a rare neurological disorder that causes debilitating nerve damage.
Without timely treatment, Early is unable to walk, care for herself independently, or even hold a fork. “I’m sick, and I need medication, and they’re just—it’s fallen on deaf ears for some reason,” Early shared.
Early’s condition was diagnosed earlier this year following a hospital visit where she was admitted with severe leg pain and inability to walk. Medical professionals prescribed Intravenous Immunoglobulin therapy (IVIG), which showed promising results during a five-day infusion treatment. “Within those seven days on that medicine, I was able to, with a walker, put weight on my feet and able to move a little bit,” she said.
However, when time came for her next dose of IVIG, Blue Cross Blue Shield denied coverage. Despite her doctors’ appeals and submission of additional documentation, the insurance company continued to refuse payment. Further compounding the issue, Early was also denied coverage for Vyvgart Hytrulo, a daily injection recently made available through a free trial offered by the drug manufacturer that also treats CIDP.
Seeking additional recourse, Early requested an external appeal through the Oklahoma Insurance Department. This review led to an overturned denial for the Vyvgart Hytrulo medication.
When News 4 reached out to Blue Cross Blue Shield of Oklahoma, the insurer declined to comment on Early’s specific case but issued a general statement: “Blue Cross and Blue Shield of Oklahoma is committed to providing access to quality health care – putting members first and helping them receive appropriate, covered care.”
The insurer further explained that prior authorization decisions are based on a comprehensive review of the member’s benefits, health condition, and adherence to nationally recognized clinical treatment guidelines. “We can’t comment on specific member inquiries,” the company reiterated.
Elizabeth Early is among many patients who face hurdles when seeking approval for costly or specialized medical treatments. The ongoing delays and denials pose serious risks to her health. “I do know the longer I go without treatment, the worse off it’s going to be for me in the long run,” Early emphasized.
This case sheds light on the challenges patients with rare diseases encounter when trying to secure insurance coverage for life-saving medications. Advocates continue to call for more transparent and patient-centric policies within the insurance industry to prevent unnecessary suffering caused by bureaucratic denials.
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