TAMPA, Fla. — Five months after an insurance denial threatened to leave a Florida brain tumor patient facing the cost of life-saving surgery, Broqsten Bunt says he has received two pieces of news: He is medically cleared, and the nearly $1 million in medical care billed following his surgery has been wiped down to zero.
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“Blessed to be in this position, thank you for all of your help," Bunt told Tampa Bay 28 Investigative Reporter Katie LaGrone recently. "Everything is working like it used to pre-surgery, and I've got my strength back,”“No prescriptions ... no future medical needs.”
Five months earlier
When we first met the 36-year-old West Palm Beach man in June, his health and finances were both uncertain.
Bunt is a childhood leukemia survivor. But the radiation therapy that helped rid his body of cancer as a child has taken a toll on him as an adult. He’s developed an aggressive brain tumor known as a meningioma. Doctors believe it was connected to the radiation treatment he received as a child.
Bunt lives in West Palm Beach. His neurosurgeon near his home said he needed to get the tumor removed and referred him to Tampa General Hospital and a specific neurosurgeon because of the complexity of his case.
Then came the denials
Although the hospital was in-network with his insurer, Florida Blue, the surgeon was not. As a result, just before his scheduled operation, Florida Blue denied an appeal for additional coverage for the out-of-network care.
In June, Bunt moved forward with the surgery anyway. He invited us to speak with him from his hospital recovery room. At the time, Bunt described being caught between his doctors and his insurance company.
“I'm taking calls from the insurance side, I'm taking calls from the medical office side,” he told us. “I'm like, I don't write the bills, I don't pay the bills. Why are you calling me? Call each other and figure it out.”
Then, in the middle of the interview, Bunt's case took a dramatic turn.
A Tampa General Hospital spokesperson interrupted our interview with an update, stating that hospital leadership had worked with Florida Blue and the insurer had agreed to cover Bunt's preoperative workup, surgeries, hospital admission and postoperative care. Neither Tampa General Hospital nor Florida Blue explained to us at the time what specifically prompted the reversal.
Read our original investigation: Florida brain tumor patient denied insurance coverage for surgery gets full reversal [tampabay28.com]
Five months later
Today, Bunt said his recovery is going well and he has been medically cleared.
And when asked whether Florida Blue ultimately paid his medical bills, Bunt said, “It appears that way.”
“So you have zero balance?” LaGrone asked.
“Zero balance,” Bunt said. “$993,000, almost a million dollars, is what the retail value of what was billed.”
Bunt said Tampa General Hospital continued working with him until his deductible was also reduced to zero. A spokesperson from TGH confirmed his insurer paid the full hospital portion of his claim
For Bunt, the resolution is remarkable. But he also believes his case illustrates how difficult it can be for a patient to challenge an insurance denial.
Before the reversal, Bunt had been fighting his insurer for months over the denial. He and his wife turned to social media, appeals and eventually the news media to draw attention to his case.
Bunt nsaid he went through two denied appeals before the insurer reversed course.
“What really changed is when the news stepped in and created the awareness of the severity of my case,” he said. “I had two appeals denied, and the condition was always the same. It didn't take any added information for them to change the denial process. It took the news making the population aware," he said.
Neither Florida Blue nor Tampa General Hospital ever explained specifically why the coverage decision changed. Florida Blue told us at the time that it could not discuss individual cases but said it works with members, doctors and hospitals through its appeals process and is “pleased when we reach positive outcomes for our members.”
Now, with his surgery behind him and his surgery balance at zero, Bunt has a message for other patients challenging a health insurance denial.
“Don't back off the gas,” he said. “You just have to keep pushing and keep reaching out to people. You have to get the care you need so that you can survive,” he added. “You can deal with the details after. If you're not here, you don't have to worry about the details.”
If you are dealing with a health insurance denial over medically necessary care, let Katie know about it below.