Veteran with heart condition says insurance coverage denied by A - WDRB 41 Louisville News

Veteran with heart condition says insurance coverage denied by Anthem

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SALEM, Ind. (WDRB) – A southern Indiana man is fighting for his life after a surprising diagnosis, and his family is now fighting with the health insurance company to provide the coverage they believe he deserves.

Matthew Nunley said he got a case of the flu in June, but he still had trouble breathing months after. In November, he went back to urgent care, where he said the doctors determined his heart was enlarged.

“They sent me to the ER,” Nunley said. “And that’s when I found out that the flu, which was nothing special ... make it to my heart. Which I guess can happen as a one in 10,000 chance.”

On Nov. 29, he was admitted to Floyd Memorial Hospital through the emergency room. Doctors believe the virus attacked his heart, causing it to expand to retain fluids. A cardiologist explained Nunley has congestive heart failure.

Over the next few days, Nunley’s wife said he went through multiple tests, which showed his heart was operating at only 10 percent capacity and ruled out blood pressure or other causes for the attack.

Nunley said his cardiologist prescribed medication to help heal him and a Zoll LifeVest to protect his heart while he was away from the hospital. The vest acts as an external defibrillator, monitoring Nunley’s heart at all times. And if his heart stops, the device would automatically shock it.

"His heart is so weak,” Nunley’s wife Shelby said. “It doesn’t have the strength to get back onto a normal rhythm. So that LifeVest is necessary to shock his heart back into rhythm.”

Shelby Nunley said they requested the vest through their health insurance company, Anthem, but they were denied twice. So they signed to take responsibility of the costs on Dec. 8 and went home.

“They wanted us to try different forms of treatment before we get the LifeVest,” Nunley said about the Anthem denial. “But the issue is this is the alternate form of treatment being on the medicine and vest.”

Nunley is an army veteran and works with a home inspection company. The 31-year-old father is physically fit, which made the diagnosis and denial all the more surprising.

“We pay our monthly fees,” Shelby Nunley said. “And we do everything that an American family is supposed to do. And yet, when we find ourselves in need. We’re denied.”

If Nunley’s heart does not improve by the end of February, he could be looking at more extreme measures like a mechanical heart implant or a heart transplant.

The family is currently waiting on a third attempt at requesting coverage from Anthem. Shelby Nunley said it could take more than 100 days for a decision to be made.

She said the cardiologist also made another request to Anthem to perform a second echo of his heart on Jan. 3 to check on his progress. But the family still has not heard if the insurance company will approve that either.

“We’re on hold,” Shelby Nunley said. “We know what the cardiologist wants to do, who is the one trained for this. But Anthem is the one holding us up.”

Tony Felts, with Anthem Blue Cross and Blue Shield, responded to an email request for comment with this statement:

“I can't comment due to federal patient privacy laws. The individual would have to sign a HIPAA waiver allowing us to comment on the specifics of his case.”

Nunley intends to sign a waiver once it is provided.

The family will now pay about $9,000 to rent the vest for the three months of medication. That price does not include the hospital stay and medical tests already performed.

Nunley’s family set up a GoFundMe page to help with the costs of the vest and other medical expenses.

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