WKU Issues Statement Concerning
Nash Insurance Benefits
Bowling Green, Ky. - Officials at Western Kentucky University announced today that insurance will provide full coverage for a bone-marrow transplant for Presley Nash. Presley is the daughter of Brian and Staci Nash, a WKU employee, and has been diagnosed with mannosidosis.
The transplant procedure was initially denied under the WKU Health Plan due to its experimental/investigational nature as determined by HCC Benefits Inc., the University's re-insurance carrier and Medical Benefits Administrators (MedBen), the University's third party administrator. At the request of the Nashes, WKU filed an appeal with the Kentucky Department of Insurance for an external review decision. The external review, conducted by Bluegrass Health Network, recommended coverage under the plan, although limited to non-transplant (out-of-network) network benefits.
The Vanderbilt Clinic would not strongly consider the bone-marrow transplant and recommended the family receive additional information. Because Fairview University Medical Center in Minneapolis, Minn., agreed to provide the transplant, coverage will be provided on an in-network basis. The University has notified the Nash family of that decision today in a letter sent through their attorney. Likewise, notice has been provided to Fairview confirming coverage.
Western first became aware of Nash family's claim and Presley's condition on May 17, 2002, when their claim was denied by HCC. Although out-of-network coverage has been available to Presley since the Blue Grass Health Network ruling on July 3, 2002, University officials continued to explore all the coverage options available to Presley in order to provide her and her family with the most beneficial coverage possible.
Due to pending litigation, the University will have no further comment on the situation.
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