AUSTIN (CN) - Blue Cross and Blue Shield of Texas denied a woman's claims for spinal fusion surgery, telling her it doesn't cover "medical tourism," the woman claims in court.
Kerri Kirby sued the medical insurer in Travis County Court on Aug. 21.
Kirby says she was diagnosed with spinal degeneration due to rheumatoid arthritis in 2012 and that local doctors recommended spinal fusion surgery that would result in a substantial loss of motion.
"However, Kirby located a physician in Germany who could perform a more limited fusion that would have little or no impact on her range of motion," the complaint states. "That physician was part of the preferred providers through Blue Cross Blue Shield and in particular Blue Cross Blue Shield International."
Kirby claims she spent almost $68,000 on the procedure, hospitalization and physical therapy - the sum does not include her travel or non-medical lodging.
She said Blue Cross Blue Shield told her in April 2013 that her claim had been approved, then rejected it that August.
"The alleged basis for the denial was that Kirby's insurance contract did not cover 'medical tourism,'" the complaint states. "On Aug. 22, 2013, Blue Cross in another letter stated that 'planned surgery outside the country is considered an exclusion of the contract.'"
Kirby said she has never been provided a full copy of her insurance policy and that nothing she has seen contained any such "medical tourism" or "planned surgery outside the country" exclusions.
"The policy clearly provides for compensation, albeit possibly at a reduced level, for services rendered by providers for whom plaintiff did not obtain pre-approval and even for providers and in any Blue Cross Blue Shield network," the complaint states.
Blue Cross Blue Shield did not immediately respond to a request for comment Wednesday afternoon.
Kirby seeks damages for breach of contract and violations of the Texas Insurance Code.
She is represented by Richard Anton in Austin.