As someone living with cardiac sarcoidosis, 60-year-old Kevin Danahy can’t afford to have bad health insurance. To control the inflammation in his heart, he needs an infusion of Remicade every other month, which he gets at Beth Israel in Boston. The infusion costs thousands of dollars out of pocket, so Danahy typically opts for costly PPO plans for reliable coverage.
This past spring, when his wife got a job at nursing home operator Stellar Health Group, Danahy joined her health plan. Like always, he reached out to his doctor to start the process of getting insurance approval for his infusions. The approval, viewed by Fierce Healthcare, came from Anthem Blue Cross Blue Shield and acknowledged the medication was medically necessary.
“There was nothing to make me question whether or not this would be covered,” Danahy said. “It looked good to me, and it looked good to my doctors.”