Mystic — Anthem Blue Cross/Blue Shield told Groton teacher Brad Vernet Thursday afternoon that it will fully cover his April 10 kidney transplant at Brigham and Women's Hospital in Boston.
On Wednesday, Vernet had said he was considering delaying that surgery and facing the prospect of going on dialysis after Anthem told him last week he was not fully covered for the procedure because the hospital is not in his insurance network for kidney transplants.
That meant he was facing a bill of $50,000 to $100,000. Vernet, whose kidney function has dropped to 8 percent, said postponing the surgery would give him a chance to find an in-network hospital to do the transplant.
Vernet, who lives in Mystic, said that last July he received a letter from the hospital saying he was "adequately covered" for the surgery. When he and his wife Katy questioned the financial counselor for transplant surgery about what that meant, they said they were told that meant there was 100 percent coverage.
Thursday afternoon, one day after U.S. Sen. Richard Blumenthal, D-Conn., pressed Anthem to fully cover Vernet, Anthem called Vernet to tell him it would do so.
While Brigham and Women's is usually considered out of Anthem's kidney transplant network, Anthem spokeswoman Sarah Yeager said there are some unique aspects of the contract the company has with Groton teachers that call for the surgery to be covered in full.
"Upon further review and closer scrutiny of the unique language of Mr. Vernet's benefits plan, we have confirmed that his benefits cover the kidney transplant at Brigham and Women's Hospital as an in-network benefit. We have contacted Mr. Vernet to let him know that the surgery will be covered at an in-network benefit level. We at Anthem take seriously our commitment to delivering quality products and service," she wrote in an email.
Vernet said he was "really relieved" to get the news.
He added it was an even bigger relief knowing he can have the transplant on time and avoid going on dialysis.
Blumenthal, who Vernet contacted for help on Wednesday afternoon, said Thursday afternoon that Anthem's review and decision were the direct result of the intervention of his office.
Blumenthal contacted a high-ranking Anthem official immediately after receiving Vernet's call, and his staff forwarded information stressing the immediacy of Vernet's situation along with media reports to Anthem. Blumenthal's staff also stressed Vernet's coverage was a priority for the senator.
"This was very much the result of our coming down hard on them and persuading them to do the right thing," Blumenthal said. "We're proud to have intervened on Mr. Vernet's behalf."
Blumenthal said he frequently receives calls from constituents looking for help with health insurance problems, and he and his staff try to help them get the coverage they need.
"There's a real lesson here for people. They should not take no for an answer and insist their insurance company give them the benefits they deserve," he said.