Anthem expands coverage for deep brain stimulation after NBC reporting

Anthem Blue Cross Blue Shield approved deep brain stimulation for Cambrie Sharp just three days after NBC News first reached out in April, then updated its medical policy to cover the procedure for certain children. The turnaround puts a hard question at the center of the case: why did a family have to fight so long for a treatment that the insurer later deemed medically necessary?

Cambrie’s story is stark. She had her first seizure at age 4 and by age 6 was living with daily, uncontrolled seizures. Born at 27 weeks gestation, she was described as a micro-preemie, and her condition had already outlasted multiple drug treatments by the time deep brain stimulation emerged as an option. Anthem initially denied coverage for the procedure before reversing itself after the news organization pressed the company about the case.

The insurer’s current medical policy now says deep brain stimulation may be medically necessary for epilepsy in people with focal partial-onset seizures when the condition is refractory to two or more antiepileptic medications. The policy also extends coverage to some pediatric patients and lists primary dystonia, obsessive-compulsive disorder and other criteria. That shift suggests the original denial rested on a narrower standard that no longer matched the clinical circumstances in Cambrie’s case.

The episode also fits into a much larger pattern. NBC’s Cost of Denial project examined hundreds of pages of insurance and medical records, interviewed dozens of patients, doctors and advocates, and found that patients across conditions are routinely pushed into prolonged battles over care. The newsroom says health insurers issue millions of prior authorization denials every year, leaving many families trapped in a convoluted appeals process that can delay treatment until outside pressure forces a reconsideration.

Cambrie’s case stands out because it did not just resolve one child’s coverage fight. It exposed how a denial can become a policy problem, and how quickly a medical-necessity rule can lag behind real-world care when advanced treatments are already being used after standard therapies fail. For families confronting severe illness, the path to treatment still depends too often on whether they can withstand the appeal long enough to make an insurer change its mind.