Insurance company denies surgery that saved man’s life for 7th time Jonathan Douglas, 49, used to walk seven miles a day just a year and a half ago. Now he has trouble getting 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, used to walk seven miles a day just a year and a half ago. Now he struggles to get to the mailbox at his Henry County home.
“I’m going to get up and go to the bathroom and pass out on my living room floor,” Douglas said. Channel 2 Consumer Investigator Justin Gray.
Doctors say that Douglas’s heart’s pumping strength is only 10-15%. He suffers from congestive heart failure.
But there is a procedure that his doctors at Emory Midtown Hospital say will get him back up and moving normally again.
This is called a Barostim implant. It was approved by the FDA in 2019. The problem is that her insurance company has denied coverage for the implant seven times.
After a sixth refusal, his Henry County doctors sent him to Emory. There, a specialist scheduled the operation again. But Anthem Blue Cross Blue Shield denied coverage the day before.
Anthem wrote in his rejection letter that he refused the implant because it would not help lower blood pressure.
But Douglas does not have high blood pressure. His problem is a failing heart caused by chemotherapy used to successfully fight leukemia.
“If the insurance company is going to deny me this procedure, make a suggestion, tell me what else I can do. Am I just supposed to give up? I don’t know. I’m at my wit’s end now,” said Douglas.
Anthem sent us a statement saying:
“This question has been reviewed in accordance with Anthem’s clinical guidelines, which are based on scientific evidence published in the peer-reviewed medical literature and other factors that show demonstrated benefit. Members always have appeal rights, including external review by an independent review body.
“I thought many times that I was nothing more than a racehorse with a broken leg, and the horse trainer decided to drop me off and Anthem Blue Shield is my horse trainer,” said said Douglas.
The cost of the procedure without insurance is over $250,000.
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