Katskee v. Blue Cross/Blue Shield of Nebraska

Sindie Katskee (plaintiff), diagnosed with a genetic breast-ovarian carcinoma syndrome that gave her a 50% cancer risk (up from a baseline 1.4%), was advised by her physicians to have her uterus, ovaries, and fallopian tubes removed even though she had not yet developed cancer. Before the surgery, she filed a claim with her insurer, Blue Cross/Blue Shield of Nebraska (defendant), which denied coverage on the ground the surgery was not medically necessary and not covered, without consulting medical literature or a review committee. Katskee had the surgery anyway and sued for breach of contract. The district court granted summary judgment for the insurer, holding her condition wasn't a covered "bodily illness" or "disease" and that the insurer had discretion over medical necessity. Katskee appealed.