A metro Atlanta gentleman says his coverage firm refuses to shell out for a lifestyle-preserving surgical procedure.
Jonathan Douglas, 49, utilized to stroll seven miles a day as not long ago as a calendar year and a 50 percent ago. Now, he has problems just having out to the mailbox of his Henry County property.
“I’ll get up and go to the lavatory and go out on my living home flooring,” Douglas told Channel 2 customer investigator Justin Gray.
Doctors say the pumping toughness of Douglas’ coronary heart is at only 10-15%. He’s in congestive coronary heart failure.
But there is a method his medical doctors at Emory Midtown Healthcare facility say will have him back again up and shifting typically all over again.
It is known as a Barostim implant. It was Fda authorised in 2019. The trouble is his coverage firm has denied protection for the implant 7 instances now.
Soon after a sixth denial, his medical doctors in Henry County despatched him to Emory. There, a expert as soon as once again scheduled the medical procedures. But Anthem Blue Cross Blue Shield denied protection the working day right before.
Anthem wrote in his denial letter that it denied the implant due to the fact it would not support reduced blood pressure.
But Douglas does not have higher blood force. His issue is a failing heart prompted by the chemotherapy utilised to successfully fight leukemia.
“If the insurance plan organization is heading to deny me from this procedure, make a recommendation, explain to me what else I can do. Am I just supposed to give up? I really do not know. I’m at wit’s conclude now,” Douglas mentioned.
Anthem despatched us a statement, saying:
“This make a difference was reviewed in accordance with Anthem’s medical guidelines, which count on scientific evidence published in peer-reviewed health care literature and other variables that demonstrate a shown gain. Associates are normally afforded attractiveness legal rights, including external evaluation with an independent critique group.”
“I have imagined various situations I’m practically nothing a lot more than a racehorse that has a damaged leg, and the horse trainer has made a decision to put me down and Anthem Blue Shield is my horse coach,” Douglas mentioned.
The price tag of the course of action without coverage is additional than $250,000.