Empire BlueCross BlueShield has reversed its decision to not cover a multiorgan transplant for a New York City man suffering from a rare appendix cancer following conversations with the Cleveland Clinic, according to WABC.
"Together with Mr. Di Laura's medical team, our clinical team made the decision to cover Mr. Di Laura's procedure with the surgeon at the Cleveland Clinic," a spokesperson told Becker's July 15. "The transplant surgeon provided additional information to demonstrate this procedure has shown early promise in case reports from the UK and could be the only option left that may improve health outcomes for Mr. Di Laura. We will continue to support him and his family as we move forward."
Anthony Di Laura was diagnosed with pseudomyxoma peritonei two years ago, a rare cancer that only affects 2 in every 1 million people. The cancer began in his appendix and spread to other organs. He had chemotherapy and surgery to remove his appendix and some areas of his stomach, but to no avail.
Mr. Di Laura was approved for a multiorgan transplant surgery and the pre-testing services by physicians at Cleveland Clinic. The surgeon, Anil Vaidya, MD, was the first in the world to perform the surgery in September, with no evidence of cancer recurrence in the patient to date.
Empire BCBS had denied the surgery for Mr. Di Laura three times, citing it as "investigational."
According to WABC, Empire wrote in its denial letter to Mr. Di Laura that "medical studies do not show that this surgery is safe or will improve your short or long-term health if there has been this type of spread. We also got an opinion from a doctor outside of our health plan. This doctor treats people with your condition. This doctor agrees that medical studies do not show that this surgery is safe or will improve your short or long-term health."
Because three appeals are the maximum possible, the Clinic submitted paperwork July 12 to New York state to request an independent review of the situation.
The cost of the surgery without coverage could range from $500,000 to $1 million, and the family has so far raised nearly $200,000 on GoFundMe.