Anthem Expands Deep Brain Stimulation Coverage to Children for 3 Disorders After $100,000 Denial
Updated
Updated · NBC News · May 27
Anthem Expands Deep Brain Stimulation Coverage to Children for 3 Disorders After $100,000 Denial
1 articles · Updated · NBC News · May 27
Summary
Anthem Blue Cross Blue Shield updated its policy to cover deep brain stimulation for children and adolescents with epilepsy, OCD and dystonia when other clinical criteria are met.
The change came after Anthem first denied 13-year-old Cambrie Sharp's epilepsy procedure days before surgery, then reversed course three days after NBC News sought comment, saying it had received fuller medical information.
Cambrie's doctors at WashU Medicine said the treatment could help after more than 20 anti-seizure medications, a corpus callostomy and a vagus nerve implant failed to stop her multiple daily seizures.
Deep brain stimulation can cost up to $100,000 without insurance, and pediatric specialists said denials are common because many devices win FDA approval based on adult trials rather than child-specific studies.
Cambrie's surgery is now scheduled for June, and doctors said Anthem's broader policy shift could improve access for other children with severe, treatment-resistant neurological disorders.
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Landmark Anthem Policy Shift Unlocks Deep Brain Stimulation for Children: Impacts, Evidence, and the Future of Pediatric Neurological Care
Overview
Anthem Blue Cross Blue Shield made a major policy change by expanding coverage for deep brain stimulation (DBS) to children and adolescents with epilepsy, OCD, and dystonia. This shift was sparked by the story of Cambrie, a 13-year-old girl who suffered years of severe epilepsy and faced insurance denial for DBS due to lack of FDA approval for her age group. Media attention and advocacy highlighted her struggle, leading to public pressure and expert support for DBS in children. As a result, Anthem reversed its decision, improving access to advanced neurological care for young patients who have exhausted other treatments.