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.