Insurance appeal during recovery

Just days after release from Northwestern Hospital, I'm home feeling pretty good about my decision to pursue HSCT.  I'm now walking short distances with no cane, driving my car and getting things done. This has included fun things like hosting a mini Superbowl party, and cooking up a batch of homemade chili. I'm standing, yes standing, at my kitchen counter and chopping up fresh vegetables. Before I had to lean on the counter and stove, which made chopping and cooking difficult.

I can visit with people if they aren't sick. Just no large groups yet. My immune system is still rebounding. Once a week, I get blood drawn to monitor my immune system's progress. The first blood test since I got home showed that I'm on track.

BCBS Minnesota has refused to pay for my HSCT treatment, even after three appeals. Their repeated reason for the denial is that they will not pay for an investigative treatment.

Job one for me now is crafting a written appeal to the State of Minnesota. If I make a convincing case, the State may compel my insurer to honor its contract and pay for my treatment. Since I paid up-front out of my life savings in order to secure a spot at Northwestern Hospital under Dr. Burt's care, that would mean I'd eventually get my $125,000 back.

My case will make the following key points:
Urgent Need
--I had been failed by multiple rounds of conventional MS drug treatments and procedures since my MS diagnosis in 2007.
--A rapid acceleration of the disease in June 2013 and six new brainstem lesions had put me in a wheelchair.
--Stopping the disease quickly was crucial to prevent permanent nerve damage and disability.
--High-dose chemotherapy followed by HSCT is the only proven way  to quickly and permanently stop the aggressive autoimmune attacks I was having.
--HSCT is more cost-effective than continued use of MS drugs, which average $55,000/year, have side-effects, and merely slow the disease.

HSCT should no longer be considered "investigative."
--More than 100 MS patients have been treated with HSCT by Dr. Burt since 1996 with no mortality.
--Thousands of cancer patients have been treated with HSCT around the world. The language often used to describe this is bone marrow transplant.
--BCBS Minnesota refused to speak with Dr. Burt about the merits and safety of HSCT for my case.
--Many other insurance companies have paid for HSCT treatment.

I'm not the only Dr. Burt patient who has had trouble with BCBS Minnesota. Fortunately, I have received guidance from a previous Dr. Burt patient whose BCBS rejection was overturned at the state level. I hope to repeat his success. Also, my old friend and colleague Bernie has offered to review my submission and offer advice before I send it. He served as Minnesota Commerce Commissioner under the Ventura administration. Among other things, he was a champion for health insurance consumers. His advice will be invaluable.

This TV News feature covers a mother with MS who is trying to shame BCBS into paying. I hope it works for her. The video also includes an interview with astute comments by Dr. Burt.

https://www.youtube.com/watch?v=i6ngmOpzQ2I