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Insurance coverage battle leaves patient in surgery limbo

Insurance coverage battle leaves patient in surgery limbo
YOU STILL A LIFE SAVING SURGERY WILL NOT HAPPEN FOR NOW BECAUSE A WOMAN FROM SANTA FE COUNTY SYSTEMS, HER INSURANCE COMPANY, IS KEEPING HER IN LIMBO. ACTION 7 SPORTS ANDRES VALLE VIOLENT TO HER CLAIMS AND IS LIVE REACTION FROM BOTH SIDES. YEAH. BRITTNEY ATKINSON’S SUFFERS FROM A RARE CONDITION. HER DOESN’T GET TO HER ORGANS PROPERLY BECAUSE OF PRESSURE ON HER ARTERIES IN ORDER TO GET HER CONDITION UNDER CONTROL, SHE NEEDS A LIFE SAVING SURGERY. BUT SHE CLAIMS HER INSURANCE COMPANY IS NOT HELPING COVER THOSE COSTS. IT’S PAINFUL. AND ALSO REALLY IMPACTS MY ABILITY TO JUST FUNCTION DAILY. BRITTANY HANSEN SUFFERS FROM THREE RARE VASCULAR COMPRESSION SYNDROMES AND NEEDS A LIFE SAVING SURGERY. I WAS DIAGNOSED IN OCTOBER. AND MY SURGEON WANTED TO GO AHEAD AND DO SURGERY RIGHT AWAY. THAT NEVER HAPPENED BECAUSE SHE SAYS HER INSURANCE COMPANY, BLUE CROSS BLUE SHIELD OF NEW MEXICO, TOOK MONTHS TO GET BACK TO HER. AND IT TOOK ABOUT THREE MONTHS TOTAL FOR THEM TO FINALLY SAY YES, YOU HAVE A MEDICALLY NECESSARY CONDITION. YOU NEED SOME FORM OF TREATMENT. AND WE’LL ALLOW THIS SURGERY TO COUNT TOWARD YOUR IN-NETWORK BENEFITS. DIAGNOSIS IS RARE, AND ONLY A HANDFUL OF SURGEONS PROVIDE THIS TYPE OF SURGERY. SO BRITTANY FOUND A DOCTOR IN LOS ANGELES WHO AGREED TO PERFORM THE PROCEDURE. BUT IT’S EXPENSIVE SINCE THE DOCTOR IS OUT-OF-NETWORK. HONESTLY, I THINK I’M LOOKING AT HUNDREDS OF THOUSANDS OF DOLLARS WORTH OF BILLS JUST TO HAVE THE SURGERY ON JANUARY 9TH. HER INSURANCE COMPANY SENT HER THIS LETTER SAYING ONLY TWO OF THE THREE PROCEDURES WOULD BE APPROVED. REACH OUT TO BLUECROSS BLUESHIELD NEW MEXICO TO SEE IF THEY HAVE ANY IN-NETWORK DOCTORS FOR THIS PROCEDURE. THEY SUGGESTED SURGEONS FROM THE MAYO CLINIC OR THE CLEVELAND CLINIC. BRITTANY SAYS SHE DID WORK WITH BOTH LOCATIONS BUT WAS TOLD SHE WAS NOT A GOOD FIT BECAUSE OF THE COMPLEXITY OF HER CONDITIONS. EVEN THOUGH IN MY POLICY IT SAYS THAT IF I HAVE A GAP IN NETWORK CARE, WHICH I DO AND A MEDICALLY NECESSARY CONDITION, I HAVE THE RIGHT TO APPLY, TO HAVE COVERAGE. NOW, BRITTANY IS ASKING SENATORS BEN RAY LUJAN AND MARTIN HEINRICH FOR HELP. BOTH OFFICES INQUIRING. BLUE CROSS BLUE SHIELD AS TO WHY A NETWORK GAP EXCEPTION WOULD NOT BE APPROVED. I AM SO STRESSED. I HAVE MOUNTING BILLS AND I KNOW I’VE GOT COSTS COMING UP WITH SURGERY AND JUST THE NOT KNOWING AND NOT FEELING SUPPORTED IS JUST REALLY, REALLY STRESSING ME OUT. AND BRITTANY DID TELL ME THAT SHE STILL PLANS ON HAVING THAT SURGERY OUT IN LOS ANGELES IN EARLY FEBRUARY, EVEN THOUGH ONLY TWO OF THOSE THREE PROCEDURES WERE APPROVED. I DID REACH OUT TO BLUECROSS BLUESHIELD NEW MEXICO AND THEY SENT ME THIS STATEMENT. IT READS IN PART, WE RESPECT OUR MEMBERS PRIVACY AND DO NOT PUBLICLY DISCUSS THEIR PERSONAL OR BENEFIT INFORMATION. WE WORK WITH OUR MEMBERS AND EMPLOYER GROUPS TO KEEP THEM INFORMED. REPORTING LIVE I
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Insurance coverage battle leaves patient in surgery limbo
Brittany Atkinson suffers from three rare vascular compression syndromes. Median arcuate ligament syndrome. Superior mesenteric artery syndrome. Renal nutcracker syndrome and needs life-saving surgery.“It's painful. It also impacts my ability to function daily,” Atkinson said. Atkinson was diagnosed in October and was told she needed surgery right away. Instead, that surgery never happened because she says her insurance company – Blue Cross Blue Shield of New Mexico – took months to get back to her. “It took about three months total for them to finally say, yes, you have a medically necessary condition, you need some form of treatment and will allow this surgery to count toward your in-network benefits,” said Atkinson. Her diagnosis is rare and only a handful of surgeons provide this type of surgery. So Atkinson found a doctor in Los Angeles who agreed to perform the procedure, but it's expensive since the doctor is out of network. “Honestly, I think I'm looking at probably several hundreds of thousands of dollars worth of bills just to have this surgery,” said Atkinson. On Jan 9. her insurance company sent her a letter saying only two out of the three procedures would be approved. We reached out to Blue Cross Blue Shield of New Mexico to see if they have any in-network doctors for this procedure and they suggested surgeons from the Mayo Clinic or the Cleveland Clinic. Atkinson claims she did work with both locations but was told she was not a good fit because of the complexity of her conditions “Even though in my policy it says that if I have a gap in-network care, which I do, and a medically necessary condition, I have the right to apply to have coverage,” said Atkinson.Now Atkinson is asking Sens. Ben Ray Lujan and Martin Heinrich for help.Both offices inquired about Blue Cross Blue Shield as to why a network gap exception will not be approved. “I am so stressed. I have mounting bills and I know I've got costs coming up with surgery. Just not knowing and not feeling supported is just really, really stressing me out,” said Atkinson.

Brittany Atkinson suffers from three rare vascular compression syndromes. Median arcuate ligament syndrome. Superior mesenteric artery syndrome. Renal nutcracker syndrome and needs life-saving surgery.

“It's painful. It also impacts my ability to function daily,” Atkinson said.

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Atkinson was diagnosed in October and was told she needed surgery right away. Instead, that surgery never happened because she says her insurance company – Blue Cross Blue Shield of New Mexico – took months to get back to her.

“It took about three months total for them to finally say, yes, you have a medically necessary condition, you need some form of treatment and will allow this surgery to count toward your in-network benefits,” said Atkinson.

Her diagnosis is rare and only a handful of surgeons provide this type of surgery.

So Atkinson found a doctor in Los Angeles who agreed to perform the procedure, but it's expensive since the doctor is out of network.

“Honestly, I think I'm looking at probably several hundreds of thousands of dollars worth of bills just to have this surgery,” said Atkinson.

On Jan 9. her insurance company sent her a letter saying only two out of the three procedures would be approved.

We reached out to Blue Cross Blue Shield of New Mexico to see if they have any in-network doctors for this procedure and they suggested surgeons from the Mayo Clinic or the Cleveland Clinic.

Atkinson claims she did work with both locations but was told she was not a good fit because of the complexity of her conditions

“Even though in my policy it says that if I have a gap in-network care, which I do, and a medically necessary condition, I have the right to apply to have coverage,” said Atkinson.

Now Atkinson is asking Sens. Ben Ray Lujan and Martin Heinrich for help.

Both offices inquired about Blue Cross Blue Shield as to why a network gap exception will not be approved.

“I am so stressed. I have mounting bills and I know I've got costs coming up with surgery. Just not knowing and not feeling supported is just really, really stressing me out,” said Atkinson.