Giacomo Bologna | Mississippi Clarion Ledger

Sarah Warnock, Clarion Ledger

Dr. Bryan Hierlmeier and his wife Lauren didn’t plan on living in Mississippi for long.

The pair fell in love at a college in Tampa and only came to the Magnolia State because of Bryan’s residency at the University of Mississippi Medical Center.

Soon after moving, they went to a restaurant.

Lauren said she was holding her infant son when someone stood up and got the door for her.

“No one does that in Florida,” Lauren said.

Lauren never forgot that small — but powerful — gesture and she thought it meant Mississippi was a place where people truly cared for each other.

Bryan and Lauren Hierlmeier came to appreciate the slower pace of life, the kindness of strangers and the strong Christian faith of many Mississippians.

Bryan was named chief resident at UMMC in 2014 and had several job offers after completing a fellowship in North Carolina, his wife said. He and Lauren chose to move to Mississippi and make it their permanent home.

“I would never move anywhere else,” Lauren said.

Now, their decision is having life-altering consequences.

The fight begins

Bryan, 36, has brain cancer.

As a doctor at UMMC, he gets his insurance through the state of Mississippi, as do more than 185,000 state employees, according to the Mississippi Department of Finance and Administration.

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Lauren said the state's insurance plan won’t cover the cancer treatment that she and Bryan believe he needs.

She wonders how many other Mississippians are being denied similar cancer treatment.

"It's hard to sit on the phone with these people who just look at a piece of paper and stamp it and go on to the next case. You don't know Bryan," Lauren said. "...If you're by yourself and you don't have someone to speak and fight on your behalf, you cave to the insurance company and you're (putting) your money in their pocket. I hate to say it, but it's true."

Blue Cross & Blue Shield of Mississippi, which administers the state's insurance plan, declined to comment on Bryan's case. The Mississippi Department of Finance and Administration, which oversees the state employees' insurance plan, did not respond to a request for comment.

While Lauren is taking care of their two children in Madison, Bryan is undergoing proton therapy at M.D. Anderson, a hospital in Houston, and will be there for several weeks.

She sat down with the Clarion Ledger for an interview May 21.

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Health insurance denies Mississippi doctor's cancer treatment

A shocking diagnosis

Lauren and Bryan met through the athletics department of the University of South Florida.

She was a sophomore studying marketing and was on the cheer team. He was a senior studying pre-med and was on the baseball team.

They connected instantly, Lauren said.

"He's patient and calm, and I'm not as much," Lauren said, laughing. "I liked that about him."

Lauren described her husband as athletic, 6-feet tall with blue eyes and always smiling, always talking to someone.

"He's a people person. He's a doer. He's brilliant. He's selfless," Lauren said. "... He never wanted to be a doctor for money. It was always to help someone."

Dr. Doug Bacon, chair of the Department of Anesthesiology at UMMC, had nothing but positive things to say about Bryan, noting that he's especially beloved among the residents.

"His knowledge, warmth and charm are missed on a daily basis," Bacon wrote in a letter.

Bacon said Bryan is a skilled doctor, calling him "a master of transesophageal echocardiography."

"In the operating room, there is no anesthetic that Dr. Hierlmeier cannot perform," Bacon wrote. "...Universally, the surgeons like and respect Dr. Hierlmeier. Often they request him to give anesthetics for their most difficult cases."

Lauren said her husband keeps his body in shape and his mind sharp, so when he had his first migraine, she thought it was something minor, like a problem with his sinuses.

But they kept happening.

In March, about a month shy of their 10-year anniversary, Bryan had his fourth migraine.

It kept him awake through much of the night, Lauren said, and she knew it wasn't normal.

"I pretty much told him, 'Put on your clothes. I'm taking you to the hospital," she said.

There was a CAT scan, then an MRI.

Lauren said she remembered exactly what her husband said after the diagnosis: "I'm just glad that this is happening to me and not you because I'm tough and can handle it."

"I knew he'd be okay," Lauren said, tearing up. "And I still feel that way."

The doctors had to move quick.

Within a day of the diagnosis, the cardiac anesthesiologist found himself in a hospital gown.

Lauren said he was talking to the nurses about the narcotics they were using on him when he was told: "Take some time. Stop being a doctor and be a patient."

The surgery took three hours and left Bryan with a scar on the right side of his head that looks like the stitching of a baseball, Lauren said. She spent most of that time praying.

About a week later, Lauren said UMMC radiology oncologists said he needed radiation for the tumor and recommended he get proton therapy.

They were excited about the treatment, Lauren said. Then came the denial.

Proton therapy vs. photon therapy

Doctors first used radiation therapy on cancer patients more than a century ago.

Typically, radiation therapy works by using photons to damage cancer cells, but the treatment can damage nearby healthy cells.

In Bryan's case, the cancer was in his brain, and Lauren said doctors told them the radiation therapy could affect his vision and lower his IQ over the coming years, possibly ending his career as a doctor.

Lauren doctors recommended Bryan get proton therapy — that's proton with an "r."

There's no medical center in Mississippi that offers proton therapy.

The Particle Therapy Co-Operative Group tracks news about proton therapy treatment.

According to the group's website, there are 31 proton therapy treatment centers in the U.S. The first one opened in California in 1990, though most have opened within the last five years.

"It's not something that's new," Lauren said.

M.D. Anderson, the Texas hospital where Bryan is being treated, says proton therapy allows doctors to pinpoint where the radiation goes and limit damage to healthy tissue.

According to the Mayo Clinic: "Studies have suggested that proton therapy may cause fewer side effects than traditional radiation, since doctors can better control where the proton beams deposit their energy."

Lauren said Blue Cross & Blue Shield of Mississippi denied the claim for proton therapy claiming it was unnecessary and experimental.

Lauren suspects the claim was denied because she said Bryan's proton therapy is more expensive than traditional radiation therapy. They have been borrowing money from family to pay for the cancer treatment, which she estimated will cost $150,000 out-of-pocket.

A Blue Cross & Blue Shield spokesperson declined to speak to a reporter on the phone.

The spokesperson, who did not identify themselves, said via email that the company does not decide claims, it administers them.

When asked to explain the difference, the unnamed spokesperson declined.

A national issue

The merits of proton therapy — and whether insurance plans should cover the treatment — are being argued in courtrooms across the country.

A federal judge in Florida recused himself from a class-action lawsuit over proton therapy earlier this month, CNN reported.

The judge is battling cancer himself, CNN said, and called UnitedHealthcare "immoral and barbaric" for denying coverage for proton therapy.

According to CNN, the judge said he consulted with medical experts about his own cancer and that "all the experts opined that if I opted for radiation treatment, proton radiation was by far the wiser course of action."

KFOR News in Oklahoma City reported in 2018 that an Oklahoma jury awarded a family more than $25 million after Aetna denied coverage for proton therapy.

Lauren's uncle, John Lauro, is a New York attorney and former federal prosecutor.

Lauro said that if there is a final denial for Bryan's proton therapy, the family will file a lawsuit against Blue Cross & Blue Shield of Mississippi.

"This is no longer a question of judgement because the science and medicine have moved so quickly in favor of proton therapy when healthy brain cells could be affected," Lauro said. "... It's just dollars and cents when insurance companies deny the claims."

The fight continues

Lauren said she feels a responsibility to speak publicly about her husband's cancer and the insurance denial for proton therapy.

"That's his fight," she said. "This is my fight."

Everyone covered by the state's employee insurance plan is at risk if the plan will not cover proton therapy, Lauren said, and not everyone has the same support that she and Bryan have.

"I feel that this is my way to help because I have the energy to fight for this because I feel it's right. It's the right thing to do," Lauren said.

The spokesperson for Blue Cross & Blue Shield of Mississippi emailed a statement from the company's chief medical officer, Dr. Tom Fenter.

“As Claims Administrator for the State and School Employees’ Health Insurance Plan, Blue Cross & Blue Shield of Mississippi bases medical necessity of services for the State Health Plan, to include proton beam therapy, on medical policy supported by peer reviewed clinical literature and independent Physician Reviewers," the statement said.

Lauren said she has reached out to the governor's office for help, but has heard nothing.

Gov. Phil Bryant, through a spokesman, declined to comment.

Bryant has previously talked about the need to attract and keep doctors in Mississippi.

In 2018, the president of the American Medical Association said Mississippi ranked 50th in access to physicians.

Bryan Hierlmeier moved to Mississippi and decided to practice medicine here because he loves Mississippians and he loves treating them, his wife said.

Lauren said it's sad that a man who has dedicated himself to treating Mississippians was denied a cancer a treatment, in part, through the state of Mississippi.

For now, Lauren said she spends much of the day video chatting with her husband and praying.

Submitted photo

Lauren said she and their two children will visit him in Houston once school lets out.

They are trying to stay positive.

Lauren said Bryan thinks the experience will allow him to see medical treatment through a different lens and make him a better doctor.

"We feel like this will bring us closer and bring us closer to God and (we) trust that this is happening for a reason," she said.

Editor's note: A previous version of the story incorrectly stated the location of Bryan's scar. It's on the right side of his head.