A Michigan woman has won $150,000 after her insurer failed to cover her medically necessary surgery, which was the first such operation she had in her life.
Lisa Schumann, 56, of Grand Rapids, was told her insurance plan would cover her surgery for free, but after her surgery on Oct. 5, it did not.
“I had an MRI and CT scan on my brain that were done on my birthday and it was a life-changing experience for me,” Schumann said.
“It really changed my life.
I’m not even sure what else I could have done.”
The woman, who works in a nursing home, is seeking $25,000 in damages for the $20,000 cost of the surgery.
The hospital did not return calls for comment.
The Michigan Health Insurance Plan, which Schumann was on, issued a statement saying it “will continue to be transparent about our coverage” and that the case “should have been handled differently.”
Schumann’s insurer, Anthem Blue Cross and Blue Shield, is one of more than 500 health plans in the state that cover a wide range of medical services.
Anthem has faced complaints in the past about its coverage of the procedure, and some members of Congress have called on the company to provide coverage to all Americans.
Anthem declined to comment on the case.
Schumann filed a lawsuit against Anthem and the Michigan Health Plan in April 2018, accusing the two of discriminating against her.
She argued that her employer did not provide coverage for her procedure because it was not covered by her employer-sponsored health plan.
She also said the insurance company had violated the Affordable Care Act, which states that people who cannot afford insurance must get it through work.
Anthem did not respond to a request for comment at the time.
The insurer said in a statement that it was reviewing the case and would have no further comment.