A man became a paraplegic as a result of an auto accident. Instead of simply accepting his fate, the man went outside of the United States and had a stem cell surgery preformed. He had both auto insurance and health insurance, but neither one will pay for the surgery. A court has decided that the insurers don’t have to.
Kevin Krohn, who lives in Michigan, got into a traffic accident in 2001. He was riding his motorcycle when a van struck him. The result of the impact caused Kevin Krohn to suffer a spinal fracture which left his lower body paralyzed.
He decided to try a form of stem-cell surgery that had improved the health of other people who were paraplegic. In order to have the surgery preformed, he had to leave the United States, and go to Portugal. This is because the procedure is not something that has been approved by the Food and Drug Administration.
The surgery involved taking some tissue from Kevin Krohn’s own sinus area (which had stem cells in it). The stem cells were then transplanted into his spine. The hope was that the stem cells would regenerate at least some of his spinal cord nerves. In this case, the surgery worked, at least a little. Kevin Krohn could now move his legs a little, and he regained control of his bladder.
It sounds like a really happy ending to a story about a horrific traffic accident. Unfortunately, things started going badly from there. The surgery cost around $51,000. His health insurance company, Blue Cross and Blue Shield of Michigan, completely refused to cover the cost of his medical bills that related to the surgery. His vehicle insurer, Home-Owners Insurance Co., also refused to cover those bills.
This lead to Mr. Krohn suing his insurance company, and a series of court cases. Ultimately, the Michigan Supreme Court decided, with a 4-3 ruling, that Home-Owners Insurance Co., (Kevin Krohn’s auto insurance company), did not have to pay for the surgery.
The court felt that the stem cell surgery was not “reasonably necessary” under state law. The court felt that the surgery was experimental because it was not approved by the Food and Drug Administration.
The attorney for Home-Owners Insurance stated that perhaps Mr. Krohn was feeling better because of aggressive therapy, and not as a result of the surgery. The attorney also pointed out that the stem cell surgery had not been tested in clinical trials, and was not approved by a United States doctor at the time that Kevin Krohn had it done.
Perhaps the most controversial part of this story has to do with the insurance company’s perception of the meaning of the state laws regarding auto insurance accidents. They feel that the purpose of the state law is to protect people who were injured in auto accidents, and not to fund “experimental research projects”.
The fear is that this loophole could be used in the future by auto insurance companies who get sued for not covering the medical bills of their policyholders. They could use the outcome of this court case as an excuse to avoid paying for injured people to get cutting-edge treatments for brain injuries and spinal injuries.
Image by Brian Turner on Flickr