After enduring Stage IV melanoma and months of immunotherapy, a woman in her 50s developed a severe inflammatory arthritis known to occur with immune checkpoint inhibitors. Her joints swelled, her mobility declined, and she could no longer walk stairs, grip a steering wheel, or care for her children without assistance. Four board-certified specialists—two oncologists and two rheumatologists—recommended infliximab, an FDA-approved therapy widely endorsed for this condition in ASCO and NCCN guidelines.

Despite this, Premera Blue Cross issued three denials over nine months on her self-funded employer plan—first calling the drug not medically necessary, then experimental, and finally claiming step therapy had not been met. None of these reasons aligned with the patient’s clinical reality or Premera’s own written policies. By the time she found Claimable through word of mouth, she had exhausted traditional appeal channels and was facing irreversible joint damage that halted her cancer treatment and jeopardized her chance of survival.

Claimable prepared a 23-page appeal letter citing extensive medical literature, national guidelines, and Premera’s own off-label coverage policy. It exposed inconsistencies in the insurer’s denial reasoning, the qualifications of their peer reviewer, and raised fiduciary concerns under ERISA. The letter was sent to Premera’s legal and executive teams—and copied to federal and state regulators.