Premera Blue Cross sparks outrage after blocking arthritis drug for a cancer survivor for nine months.
Stephanie Nixdorf, fighting Stage 4 melanoma, was prescribed infliximab to treat severe arthritis caused by her immunotherapy. Her husband’s Premera insurance denied coverage repeatedly throughout 2024. The drug was finally approved only after Nixdorf sent a 23-page AI-powered appeal letter to Premera’s CEO and multiple government agencies.
Nixdorf’s husband, Jason, connected with Claimable, a startup using AI to help patients draft data-heavy insurance appeal letters for around $40. Claimable’s CEO pitched in to craft the appeal before their official website launched. 
Two days after the letter dropped in mid-September, Premera reversed course and approved infliximab.
“I want to apologize that you have been waiting to receive treatment for nine months,” Premera wrote.
Premera blamed the delay on a “processing error” involving misapplied policies and wrong specialist review. The insurer admitted they “fell short” in Nixdorf’s case.
Denials were based on claims that the drug was "not medically necessary," "investigational," and not FDA-approved—despite infliximab being a standard treatment recommended by leading cancer networks.
Jason Nixdorf called out Premera’s denial system:
“They set the system up so people give up.”
The situation got worse when Premera outsourced independent review to AllMed Healthcare Management—led by a former Premera clinical review director, raising conflict-of-interest concerns.
Premera declined to comment on the conflict but defended AllMed’s accreditation and oversight.
More patients are turning to AI tools like Claimable and nonprofit Counterforce Health to combat insurance denials. Rheumatology specialist Tabitha Lee said AI-generated appeal letters have sped up approvals and eased her workload.
“Denials should be appealed, but we observe most people don’t appeal because they are intimidated by whole thing,” said CareYaya Health Technologies founder Neal K. Shah.
“When you get a no, please take the next step — you have rights.”
A 2025 KFF study shows insurers denied 19% of claims in ACA marketplace plans, with less than 1% of appeals succeeding. Delays and denials cause both health damage and financial strain.
The Nixdorfs see the nine-month roadblock as more than a glitch:
“Not only has the delay caused Stephanie permanent damage,” Jason said,
“it will be a lifelong thing for her to deal with this arthritis. If we had gotten the OK in January, it could have been knocked out and done then.”
