Aetna Denies Alaska Woman Life-Saving Surgery
By Consumers for Quality Care, on June 23, 2017
Photo by Heidi de Marco An Alaska woman is battling her insurance company to receive a life-saving surgery, the Alaska Dispatch News details. Barbara Ross, who supports a family of ten, has a hereditary lymphedema, which causes her body to retain fluid under the skin. After an injury, her condition worsened.
She lost the ability to exercise and her weight shot up, making the lymphedema worse. Now she can barely stand. Her legs are too big for her to drive a car. She developed hypertension, diabetes and peripheral neuropathy, with numbness and chronic pain.Ross says she used to exercise and maintain a healthy diet, something she is no longer able to do.
Her skin breaks from the pressure of the fluid. She looks like an over-inflated balloon — and she kind of is. On one of her various hospitalizations for a weight-related infection, the intravenous fluids given by doctors built up until one of her legs burst and water flowed out. Because of her illness, Ross' life is painful, unhealthy and humiliating. And costly.Ross’ doctors want her to undergo gastric bypass surgery, as a way to end the cycle of her illness.
Dr. Devery Mitchell … said the fluid retention and weight gain contribute to one another. Tackling the weight would help Ross get rid of the fluid and stay out of the hospital.In 2015, a single hospitalization due to Ross’ lymphedema cost almost $200,000. Gastric bypass would only cost a fraction of her current health costs. However, Aetna has denied the surgery, saying that the procedure is not covered by Ross’ ACA plan. Even after Ross hired a lawyer to advocate for her, Aetna continues to deny the surgery. Ross knows another means to get the surgery: if she left her job, she could get Medicaid to pay for the surgery.
"But, that's not how I want to do things. I don't want to do it the wrong way, I want to do it the right way. I paid the money for insurance. I've done what I was supposed to do. And I could understand if this was me being vain and trying to lose weight and get beautiful, but that is not what this is about. This is about me getting my life back," she said.Now, Ross’ family has gone to extreme measures to get her the gastric bypass surgery.
[I]nstead of quitting, the family is borrowing money for the operation. The mortgage on the house was five years from being paid off. Now a new mortgage has 30 years left and Ross has the money for the operation to get her life back.