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Girl Has Blunt Message for insurance Company After Brain Surgery Request Denied (Thanks, ACA)
KFOR ^ | DECEMBER 11, 2017

Posted on 12/11/2017 12:40:06 PM PST by nickcarraway

Cara Pressman sobbed in the big red chair in her living room. The 15-year-old tried to absorb the devastating news relayed by her parents: that their insurance company, Aetna, denied her for a minimally invasive brain surgery that could end the seizures that have haunted her since she was 9 years old.

“When my parents told me, I went kind of blank and started crying,” she said. “I cried for like an hour.”

Her friends had been lined up to visit her in the hospital for the surgery three days away, on Monday, October 23. Between tears, she texted them that the whole thing was off.

(Excerpt) Read more at kfor.com ...


TOPICS: Business/Economy; Extended News; Government; News/Current Events
KEYWORDS: aca; aetna; carapressman; h3althcare; insurance; obamacare
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To: nickcarraway

They could also see if this procedure is done overseas someplace. The amount of money overseas would be a fraction of what it is here and affordable.


41 posted on 12/11/2017 2:07:55 PM PST by Captain Peter Blood
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To: nickcarraway

The base salary for Aetna’s CEO is $31,000,000. And money is biggest motive for denial. Even if surgery experimental no reason to deny. That should be decisions of patient.

That bastxxd could pay for it out of his pocket and never feel it.


42 posted on 12/11/2017 2:22:35 PM PST by amihow
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To: NEMDF

No. Not experimental. Read article.


43 posted on 12/11/2017 2:23:50 PM PST by amihow
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To: usconservative

“Common sense is so dead in this country, isn’t it?”

I’ve seen a number of things that make me think an organization loses the ability to act rationally when it reaches a certain size.


44 posted on 12/11/2017 2:31:07 PM PST by dsc (Any attempt to move a government to the left is a crime against humanity.)
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To: gloryblaze

“Big Medicine shouldn’t really be doing experiments on people and expecting Big full payment. Why even bring up the existence of unproven procedures to folks and planting false hopes?”

Doesn’t that depend on the prognosis? If you’re going to die otherwise, might as well go for a low-odds experimental procedure, no?


45 posted on 12/11/2017 2:34:46 PM PST by dsc (Any attempt to move a government to the left is a crime against humanity.)
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To: amihow

I did read the article. I did not say it was experimental.


46 posted on 12/11/2017 2:43:05 PM PST by NEMDF
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To: TangledUpInBlue

TangledUpInBlue wrote:

“Crap like this has been going on for 30 years. When my son was an infant, he could not tolerate any formula because he was induced at 39 weeks. His intestines weren’t mature.

The answer was a “pre-digested” formula powder that was made in England. It wasn’t available here in the US. So his pediatrician recommended we get it. It was Dr. prescribed treatment. My son was 2-3 months old at the time.

Aetna rejected paying for the formula because they said they didn’t cover “supplemental nutrition”. At the time, I think this stuff was $300 for 4 cans and each can lasted about 5 days. So roughly $500 per month. I wasn’t making much then and it would have been extremely difficult.

They make decisions in a vacuum without understanding the facts. Even after long phone calls with them and my arguing that my son’s only food couldn’t possibly be “supplemental” they wouldn’t budge.”

What did y’all end up doing?


47 posted on 12/11/2017 2:44:41 PM PST by WildHighlander57 ((WildHighlander57, returning after lurking since 2000)
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To: Abby4116

My wife spent one afternoon and overnight in the emergency room of our local hospital. She had what is referred to as a TIA or a mini stroke. The gave her all sorts of tests, blood tests, heart monitor, scans Etc. The bill came to $25,601. Insurance company paid and the hospital accepted $2,355.

Our cost was $75 for a visit to the emergency room.


48 posted on 12/11/2017 2:48:52 PM PST by billyboy15
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To: dsc
I've been in corporate America on and off the last 30+ years (with two stints of starting my own business thrown in...) and I'm convinced you're right. I'm not sure what the size is but it seems the larger the organization, the less common sense there is.

I only recently finally realized why my own employer keeps me around at 55 in the I.T. Sector within financial services: Commmon Sense and Critical Thinking Skills.

Both of which are in short, short supply everywhere these days.

49 posted on 12/11/2017 3:08:12 PM PST by usconservative (When The Ballot Box No Longer Counts, The Ammunition Box Does. (What's In Your Ammo Box?))
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To: beef
?$300,000.00 for the surgery? When in the “old days” did they charge that kind of money for one procedure?

It's not like it's brain surgery.

.

Oh, wait, it IS brain surgery. And experimental, unproven, brain surgery at that. Maybe she can ask the local general surgeon that doesn't speak English to give it a shot.

50 posted on 12/11/2017 3:08:20 PM PST by PAR35
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To: Sgt_Schultze
Curiously though, Aetna did approve her for the "more invasive and more expensive open brain surgery, called a temporal lobectomy." You'd think if it was a money issue, Aetna would have taken the cheaper route.

Sounds like Aetna is worried about also having to pay to fix a potential bad outcome if the experimental procedure she wants to try goes badly.

51 posted on 12/11/2017 3:44:33 PM PST by PapaBear3625 (Big governent is attractive to those who think that THEY will be in control of it.)
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To: PapaBear3625

“Reading the article, Aetna did not deny her care, they just disapproved the particular treatment (laser surgery) as “experimental”. They would cover regular surgery.”

***

It seems that if she has had seizures since she was 9 then whatever Aetna covered so far HASN’T WORKED. Maybe a small ‘experimental’ approach would not be so experimental after all . . . I would not side with the insurer on this one. The insurance industry sometimes forgets that life isn’t always numbers, it’s also supposed to be about helping your PREMIUM PAYERS to get healthy.


52 posted on 12/11/2017 3:47:13 PM PST by LRoggy (Peter's Son's Business)
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To: beef
$300,000.00 for the surgery? When in the “old days” did they charge that kind of money for one procedure?

A relative had to undergo surgery a year ago. The bill was $250K. The insurance company brought them down to $79K. If you do not have the kind of bargaining position which an insurance company can wield, then you are screwed.

Plus, the hospital has to get the money to cover the care given to non-paying "customers" from somewhere. If the hospital was allowed to let shot gang-bangers bleed out without treatment, society would probably be improved.

53 posted on 12/11/2017 4:00:58 PM PST by PapaBear3625 (Big governent is attractive to those who think that THEY will be in control of it.)
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To: usconservative

“Both of which are in short, short supply everywhere these days.”

Yes, they are, especially in HR departments. It’s a wonder that your employer even knows those things when he sees them.


54 posted on 12/11/2017 4:33:02 PM PST by dsc (Any attempt to move a government to the left is a crime against humanity.)
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Comment #55 Removed by Moderator

To: TangledUpInBlue

Was that formula Pregestimil? My daughter had to have it 35 years ago. Couldn’t afford it on an E4’s pay. Thankfully the Air Force provided us with it. Had to have a prescription from the pediatrician and go to the hospital nursery twice a month to pick it up.


56 posted on 12/11/2017 8:05:09 PM PST by mom aka the evil dictator
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To: nickcarraway

They didn’t deny treatment - just experimental treatment.


57 posted on 12/12/2017 2:55:51 AM PST by trebb (Where in the the hell has my country gone?)
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To: onemiddleamerican

Sorry, I cut it short.

He’s fine now, a healthy 17 year old. What happened was, I was complaining to a co-worker who had been there longer than I had and she told me that the Head of our department was on the Corporate Benefits Committee and things like this were really important to him and that I should talk to him.

So here I was, the 24 year old newbie going to see a Global VP. He treated me like his equal in listening to me. I’ll never forget him for that. I told him the story just as I posted it here and he said let me make a few phone calls and see what I could do. I thanked him and left.

By the time I walked back to my cubicle, my phone was ringing. It was the company’s benefit coordinator at Aetna. At the time, our medical and Rx insurance were two different plans. She advised me that all I had to do, was have the Pediatrician write a Prescription for the formula and they would cover it fully. So we ended up getting a 90 day supply, for I think $30 - our Rx co-pay at the time.

Can you believe that? So again, bureaucracy, but clearly, it’s how hard you shake the tree and it helps to know people.


58 posted on 12/12/2017 5:45:10 AM PST by TangledUpInBlue
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To: WildHighlander57

I answered to another person below. Should be a current post at the bottom of this thread. Thanks!


59 posted on 12/12/2017 5:46:02 AM PST by TangledUpInBlue
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To: mom aka the evil dictator

I am almost certain that’s exactly what it was. It sounds familiar. It was 17 years ago, but that sounds familiar.


60 posted on 12/12/2017 5:47:02 AM PST by TangledUpInBlue
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