Kantor & Kantor, LLP Challenges Denial by Kaiser for Critical Treatment of Patient with Aggressive Multiple Sclerosis

Aaron Monheim, age 34, lives in Spokane, Washington with his wife and three year old daughter. In 2019, Aaron was diagnosed with aggressive relapsing remitting multiple sclerosis which has been unresponsive to medications and leaves Aaron partially disabled due to frequent flares and relapses.

Aaron’s physicians recommended him to receive a treatment called hematopoietic stem cell transplantation, found to be particularly suited for his form of relapsing remitting multiple sclerosis. The treatment will effectively reset his immune system so it will no longer attack his central nervous system. The treatment is also less costly than the traditional medications for multiple sclerosis which have been unsuccessful for Aaron.

Despite having been referred to the treatment by his own Kaiser doctor, Aaron’s health plan, Kaiser Permanente, has denied benefits for the treatment claiming the treatment is not necessary or suited for Aaron’s condition.

Kaiser’s position is refuted by at least three members of Aaron’s medical team who all recommended Aaron receive stem cell transplantation. Multiple international studies and ongoing U.S. studies support the use of stem cell transplantation for patients with relapsing remitting multiple sclerosis. A randomized clinical trial published by the Journal of the American Medical Association (JAMA) in 2019 showed an 85% event-free survival rate. Meaning, 85% of the patients who had the stem cell transplant no longer needed immunosuppressive drugs, had no further neurological damage and they become less disabled.

Aaron continues to challenge Kaiser’s denial with an administrative appeal submitted this month. Aaron’s attorney, Elizabeth K. Green at Kantor & Kantor LLP, reports Kaiser’s position is particularly detrimental to Aaron’s health because he has no other viable options for treatment at this point: “Without this medically necessary treatment, Aaron risks further relapses which could result in permanent disability. Aaron is a 34 year old man with a young family and the potential for a full life. Kaiser needs to support Aaron and immediately provide benefits for this treatment which is proven medically necessary and will allow Aaron to fully function without the grave risk of disability.”

In Aaron’s words: “This is the only shot that I have to live a somewhat normal life and not continually decline both physically and mentally.”

If you or someone you know suffers from MS and has been denied benefits, please contact Kantor & Kantor at 888-569-6013 or use our online contact form  for a free consultation.

 

 

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