Insurance company denies life-saving surgery for the seventh time – WSB-TV Channel 2

Insurance company denies life-saving surgery for the seventh time Jonathan Douglas, 49, was walking seven miles a day as recently as a year and a half ago. Now, he has trouble just going out to the mailbox.

HENRY COUNTY, GA – A metro Atlanta man says his insurance company is refusing to pay for life-saving surgery.

Jonathan Douglas, 49, was walking seven miles a day as recently as a year and a half ago. Now, he has trouble getting out to his home mailbox in Henry County.

“I’m going to get up and go to the bathroom and pass out on the living room floor,” said Douglas. Channel 2 consumer investigator Justin Gray.

Doctors say that the pumping power of Douglas’ heart is only 10-15%. He suffers from congestive heart failure.

But there’s a procedure his doctors at Emory Midtown Hospital say will get him back and moving normally again.

It’s called a Barostim implant. It was approved in 2019. The problem is that his insurance company has refused implant coverage seven times now.

After the sixth denial, his Henry County doctors sent him to Emory. There, select the surgeon again. But Anthem Blue Cross Blue Shield denied coverage the day before.

Popular stories:

Anthem wrote in his rejection letter that he denied the transplant because it wouldn’t help lower blood pressure.

But Douglas does not have high blood pressure. His problem is heart failure caused by chemotherapy used to successfully combat leukemia.

“If the insurance company is going to block me from this procedure, make a suggestion, and tell me what else I can do. Am I supposed to give up? I don’t know,” Douglas said.

Nasheed sent us a statement saying:

“This issue was reviewed in accordance with Anthem’s clinical guidelines, which are based on scientific evidence published in the peer-reviewed medical literature and other factors showing demonstrated benefit. Members are always granted rights of appeal, including external review with an independent review organization.”

“I’ve thought many times that I was nothing more than a racehorse with a broken leg, and the horse trainer decided to put me down, that Anthem Blue Shield is my horse trainer,” Douglas said.

The cost of the procedure without insurance is more than $250,000.

Related news:

%d bloggers like this: