A Mississippi doctor sued the state employee’s insurance plan and Blue Cross & Blue Shield of Mississippi this week after he was denied coverage for his brain cancer treatment.
Bryan Hierlmeier is a cardiac anesthesiologist at the University of Mississippi Medical Center in Jackson. After a bout of painful headaches this spring, he went to the emergency room where doctors discovered a tumor in his brain.
Doctors at UMMC recommended Hierlmeier undergo proton therapy, a newer form of radiation therapy designed to pinpoint the radiation and protect nearby healthy tissue.
The lawsuit said his career was at stake.
“(Traditional radiation therapy) would probably result in devastating health consequences that included adverse effects to his vision, memory loss, and cognitive impairment,” the lawsuit said. “In other words, (it) would end Dr. Hierlmeier’s career as a professor and practicing anesthesiologist, to say nothing of the impact on the quality of his life.”
His wife, Lauren, went public with their fight earlier this year, in part because she feels any Mississippians with the state’s insurance plan, including teachers, state troopers, social workers and more, are at risk of having necessary cancer treatments denied.
There are about 185,000 people on the state’s insurance plan.
Fighting for coverage
Medicare and Medicaid in some states cover proton therapy, and Blue Cross & Blue Shield of Mississippi has at times approved the treatment.
But Hierlmeier was denied — three times.
According to the lawsuit:
- The insurance plan doesn’t require a particular type of radiation therapy
- The plan doesn’t limit how much it should cost
The federal government approved proton therapy in 1988
But Blue Cross said the proton therapy was “experimental/investigational.”
The coverage was denied on appeal twice, following external review processes, which the lawsuit claimed were one-sided and a “sham.”
The external reviewers were “hired simply to rubberstamp the previous denial,” the lawsuit alleged.
According to the lawsuit, denying Bryan Hierlmeier’s proton therapy really boiled down to Blue Cross.
Blue Cross has not formally replied to the lawsuit, which was filed in Hinds County Circuit Court Thursday.
A tough decision
“I pray that people don’t have to go through the denial process,” Lauren said. “...My husband was to the point where he felt he should get substandard care because of the denials.”
Bryan struggled to sleep some nights, Lauren recalled, wondering whether he should keep fighting for proton therapy or undergo traditional radiation therapy.
“He was so worried about what decision to make and he almost caved to the insurance company,” Lauren said.
Eventually, they decided to pay for the proton therapy on their own, borrowing money from family.
According to the lawsuit, the total cost of the proton therapy was more than $155,000.
Lauren’s uncle, John Lauro, filed the lawsuit, along with a retired Mississippi judge.