Veteran Winning The Battle Against Congestive Heart Failure, Losing Battle With His Insurer For Required Care

By Consumers for Quality Care, on August 7, 2017

Matthew Nunley, a veteran, is facing the battle of his life. He has been diagnosed with congestive heart failure and is battling Anthem to cover the device keeping him alive, reports WDRB.

Nunley’s diagnoses came in November 2016, after he got the flu.

Doctors told Nunley it was a one-in-10,000 chance a virus would attack his heart like that. His heart was functioning in the 10-15 percent range when he was diagnosed.

Nunley’s doctors prescribed him a number of medications and a Zoll Life Vest.  The vest monitors Nunley’s heart rhythm and shock it if anything went wrong.  Some months later, the treatment was working and Nunley’s heart function was up to 30-35%.  Nunley described his treatment as a blessing.

But as his health improved, a new battle appeared for Nunley and his family. Anthem’ denied Nunley’s life vest. Without the insurer’s help, the cost of wearing the vest for 3 months is between $11,000-$14,000.

“We do what we’re supposed to do,” said Shelby Nunley, Matthew’s wife. “We pay the bills. We do everything we’re asked to do, and then we’re stuck with tragedy. And instead of Anthem being there to help us to make this tragedy easier, instead, they make the burden even greater.”

As the Nunley family filed appeal after appeal, their frustration with their insurer only grew.  The family felt that the insurer’s decision was being made by individuals who didn’t fully understand the gravity of Matthew Nunley’s condition.

“He shared with us that he was a gynecologist making the decision on a 31-year-old man’s heart,” Shelby Nunley said. “It was very frustrating to both of us… We’re making a decision on a cardiovascular case for a male.”

After his third appeal, Nunley was told the vest was denied because it was “medically unnecessary” and “experimental.” Nunley disagrees with his insurer’s position.

“When it would give me a warning that I was getting close to my heart being off beat, at that point I could know, ‘OK, I need to stop what I’m doing. Whatever it is, whatever is stressing me out, I need to calm down,'” he said. “Even if it never went off, it never went off because it has a warning system. Without that, I don’t think I’d be sitting here today.”

The Nunley’s believe that Anthem is the only insurer that does not cover the Zoll device.

To date, The Nunley’s have maxed out the appeals process, with 4 appeals. They are considering getting a lawyer, but fear another losing battle. They are currently paying $1,000 a month for hospital bills.