NJ dad has terminal cancer after insurance claim denied CT scan
December 20, 2024
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The cough began as an annoyance to Brad Schnure. Then it wouldn’t go away.
After seeing several doctors, a specialist ordered a neck and chest scan three years ago. But a vendor for Schnure’s medical insurance company denied the scan. The doctor appealed. It was denied again.
A year later, the 48-year-old father of three young children was diagnosed with terminal lung cancer. Schnure believes it would have been caught at a much more treatable stage if the chest scan had been approved.
“Unfortunately, my story happens countless times a day all across New Jersey and all across the country,” he said.
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Schnure, a former legislative official, has become the face of a bipartisan bill that would eliminate pre-approval by insurance companies for medical tests, procedures and prescription drugs and leave it in the hands of a patient’s doctor.
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Insurance companies have said the pre-approval process is a way to ensure that providers don’t over-test, over-prescribe or charge for unnecessary procedures just to increase their profits. But critics say it’s a way for insurers to deny coverage and contribute to massive earnings of $25 billion in 2023 with a 2.2% profit margin and executive compensation packages in the tens of millions.
The issue has come to the forefront following the shooting death of UnitedHealthcare CEO Brian Thompson this month on a New York City street. His death unleashed a torrent of criticism at the insurance industry for a litany of issues, especially coverage denial.
Luigi Mangione was charged with second-degree murder in the shooting. Shell casings found at the scene had the words “deny,” “defend” and “depose” written on them, suggesting Mangione targeted Thompson, police said, over his industry’s much-criticized role in the health care system.
Schnure said he strongly condemns Thompson’s murder, but added that the backlash to the insurance industry “should set off alarm bells in Washington and elsewhere.”
A version of the New Jersey bill — S227 — has been floating around Trenton since it was first introduced in 2019 without much movement even though it has two powerful bi-partisan sponsors in Senate President Nick Scutari, a Democrat, and Sen. Jon Bramnick, a longtime Republican leader.
It would prohibit insurance companies, third-party administrators, pharmacy benefits managers, the State Health Benefits Program and the School Employees’ Health Benefits Program from requiring pre-approval for procedures.
Bramnick said Monday that he was not optimistic the bill would gain traction even with examples like Schnure’s case. “My friends on the insurance side of this issue have a lot of power,” Bramnick said during a news conference. “They have a lot of influence over the legislature.”
A denial and a life derailed
Schnure sought medical attention for his lingering cough in early 2022. A pulmonologist performed several tests and found his lung function was fine. Schnure now says the tumor in his right lung was likely small enough at the time to cause the cough but not able to be detected without a scan.
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After a series of doctors’ visits, the consensus was that Schnure had some sinus issues that were likely causing the cough. But as a precaution an ear, nose and throat specialist had ordered a CT scan of Schnure’s chest.
While preparing for sinus surgery, Schnure had a CT scan of his head that was approved by his insurer Horizon at an in-network radiology center that cost the company $300. While the cough was still lingering, the ENT specialist ordered a CT scan of Schnure’s neck and chest, stating a diagnosis of persistent cough and “respiratory abnormalities,” according to documents Schnure posted on social media.
Horizon sent Schnure a letter two days later saying EviCore, a third-party vendor, reviewed the request and determined it would not cover the CT scan. The ENT specialist appealed and two weeks later EviCore upheld the denial saying Schnure didn’t get an x-ray first to “support further imaging,” according to a Horizon letter. Schnure and his doctor gave up trying and went along with the sinus surgery. It didn’t help the cough.
Madeline Ziomek, an EviCore spokeswoman, said in an email this week that Schnure’s account doesn’t match the company’s internal records, but did not explain further.
“It’s important that patients have access to cancer screening tests — especially for lung cancer, where screenings are too often underused,” she said in a statement. “We have specific programs in place to encourage clinicians to order these same tests more frequently and our approval rates remain very high.”
A year after the denial, Schnure’s wife, Nora, rushed him to an emergency room after he had difficulty breathing. A CT scan, which doesn’t require preauthorization in an emergency situation, revealed a mass on his right lung. He was soon diagnosed with Stage IV lung cancer, a shock to someone who had never been a smoker.
Schnure is convinced that the CT scan that was denied a year earlier would have given him a much better chance at survival. Instead, he has retired from his job at the state legislature where he was most recently communications director for the Senate Republicans.
He is receiving treatment to prolong his life and is trying to spend as much time as possible with Nora and their three children.
Schnure estimates that Horizon has received upwards of $2 million in bills for his cancer treatment.
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