Callahan v. Sledge

Illinois Appellate Court
Civil Court
Citation
Case Number: 
2012 IL App (4th) 110819
Decision Date: 
September 6, 2012
District: 
4th Dist.
Division/County: 
Sangamon Co.
Justice: 
McCULLOUGH
Holding: 
Affirmed.
Decedent, a state employee insured under state-sponsored health plan, was diagnosed with melanoma, and insurer refused to cover medication, finding it was not "medically necessary", as it was FDA-approved to treat some cancers but not melanoma. Court properly found that Plaintiff' failed to show that medication was "recommended" in formal published clinical studies, as required in Section 6.4 of State Employees Group Insurance Act. Finding that medication was investigational or experimental and not covered by health plan was supported by record. (COOK, concurring; APPLETON, specially concurring.)