Case XIII · Survived
Rick Pope
Dover Township, York County, Pennsylvania · Myasthenia Gravis · HighmarkHighmarkOne of the largest Blue Cross Blue Shield-affiliated health insurers, operating primarily in Pennsylvania, West Virginia, Delaware, and New York.
The Cheaper Option
Rick Pope lives with myasthenia gravis, a rare autoimmune disease that causes the muscles to tire and weaken quickly. It is a condition where the specific treatment matters — the therapy has to be matched to the patient. According to Pope, his neurologist recommended a particular treatment, and his insurer, Highmark, would not cover it. They would cover only a cheaper option.
A visiting nurse administered that cheaper option as an infusion at his home. About fifteen minutes after it finished and the nurse left, Pope's body reacted.
"About 15 minutes after the infusion was done at my house and the visiting nurse left, I went into anaphylactic shock. We had to call the Dover Ambulance because I stopped breathing."
"I don't remember anything for about two weeks later when I woke up with everybody staring at me."
— Rick Pope, to WHTM/abc27, June 2026
Ten Days He Doesn't Remember
Pope stopped breathing in his own home and was rushed out by the Dover ambulance crew. He woke roughly ten days later from a coma — about five months before he told his story publicly — with his family gathered around the bed, having spent those days not knowing whether he would wake at all. He said the hardest part was what it did to them: the not-knowing, the waiting.
He expects the medical bills from the episode to total as much as $1 million, and expects his insurance to pay only a portion of it.
Highmark's Statement — For the Record
"We are committed to ensuring our members receive care in the most medically-appropriate, convenient and cost-effective settings. Our medical management program is focused on assuring that the people we serve receive care that is based on established clinical guidelines, promotes positive health outcomes and aligns with their benefits. We have invested many resources in streamlining our processes with our provider partners to help the people we serve get the right care in the right setting. Additionally, Highmark's medical management policies are developed and regularly reviewed by a diverse team of medical professionals, including physicians, nurses, and pharmacists."
— Highmark, statement to WHTM/abc27, June 2026. Highmark did not comment on Mr. Pope's specific case. This account reflects Mr. Pope's description of events as reported.
What This Case Proves About the Mechanism
Most cases in the Reason Room turn on a denial that delayed or blocked care. Rick Pope's turns on a substitution — the insurer covering a cheaper alternative in place of the treatment the treating neurologist recommended. The harm here wasn't the absence of treatment. It was the treatment the coverage decision steered him toward. He received care; it was the wrong care for him, and it nearly killed him in his own living room fifteen minutes after the nurse walked out the door.
It is the cleanest possible illustration of the line that defines a medical-necessity override: a coverage decision, made away from the bedside, overriding the judgment of the doctor who examined the patient — with the patient's body absorbing the difference.
Rick Pope is the case Pennsylvania lawmakers cited for HB 2611.
His story ran in the same coverage as House Bill 2611 — which would make a health insurer's CEO criminally liable when an adverse determination of a medically necessary benefit causes serious bodily injury or death. His is precisely the fact pattern the bill describes. See the bill and its ERISA limits in The State Battlefield.
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