Drudge Retort: The Other Side of the News
Tuesday, December 12, 2017

Cara Pressman sobbed in the big red chair in her living room. The 15-year-old tried to absorb the devastating news relayed by her parents: that their insurance company, Aetna, denied her for a minimally invasive brain surgery that could end the seizures that have haunted her since she was 9 years old. "When my parents told me, I went kind of blank and started crying," she said. "I cried for like an hour." Her friends had been lined up to visit her in the hospital for the surgery three days away, on Monday, October 23. Between tears, she texted them that the whole thing was off. It was supposed to be a joyous weekend. Cara's grandparents had come to town to celebrate their 90th birthdays, a jubilant party with more than 100 family and friends crowding her home. The party did go on -- just with a lot more stress.

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Cara had multiple complex partial seizures that weekend. When the seizures strike, her body gets cold and shakes, and she zones out for anywhere from 20 seconds to two minutes, typically still aware of her surroundings.

Her seizures can be triggered by stress, by being happy, by exerting herself -- almost anything. "It's like having a nightmare but while you're awake," she said.

In the six weeks since the denial, Cara has had more than two dozen seizures affecting her everyday life.

Her message to Aetna is blunt: "Considering they're denying me getting surgery and stopping this thing that's wrong with my brain, I would probably just say, 'Screw you.'"

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"Contacted for reaction, the Epilepsy Foundation strongly objected to Aetna's remarks, saying the insurance company took its information out of context.

Laser ablation surgery "has emerged as a new minimally invasive surgical option that is best suited for patients with symptomatic localization-related epilepsy," said Dr. Jacqueline French, the chief science officer with the Epilepsy Foundation.

"This technology is much less invasive than the alternative, which involves removing a sizeable piece of brain, at a substantially higher monetary and personal cost," French said. "This path should be available, if the treating epilepsy physician has recommended it, without delay or barriers."

Phil Gattone, the president and CEO of the Epilepsy Foundation, said insurance denials and other barriers to treatment have become a common battle for thousands of Americans with seizure disorders."

These insurers do this and worse on a daily basis. Too bad they have so many poor, sick rwingers keeping them in bidness by voting Republican.

#1 | Posted by Corky at 2017-12-12 12:13 AM | Reply | Newsworthy 3

Republicans want the current private health insurance system which profits from death panels. To cover their inhumanity for the illiterate, they pretend, very loudly, that socialized medicine will bring the death panels we already have. Everybody using France's socialized medicine knows better. Better value, better care.

#2 | Posted by bayviking at 2017-12-12 08:46 AM | Reply | Newsworthy 1

"If you can't take care of your sick in the country, forget it, it's all over. I mean, it's no good. So I'm very liberal when it comes to healthcare. I believe in universal healthcare. I believe in whatever it takes to make people well and better."
--Donald Trump, as told to Larry King, in 1999

"Everybody's got to be covered. This is an un-Republican thing for me to say because a lot of times they say, 'No, no, the lower 25 percent that can't afford private' ... I am going to take care of everybody. I don't care if it costs me votes or not. Everybody's going to be taken care of much better than they're taken care of now."
--Donald Trump, to '60 Minutes'

#3 | Posted by catdog at 2017-12-12 08:47 AM | Reply

Catdog, you need to be more sensitive, some of the idiots who post here actually voted for Donald Trump.

#4 | Posted by danni at 2017-12-12 08:50 AM | Reply

If her parents really cared, they'd go to medical school and become surgeons and perform the operation themselves. No one wants to be self-reliant anymore.

#5 | Posted by visitor_ at 2017-12-12 09:46 AM | Reply | Funny: 1

I didn't vote for Trump. I hoped that his 60 minutes comment was true... That he would get the Republicans to fix somethings about healthcare, and they would do it because it was their idea.

The funny thing is that I had Aetna for a while, and they were the best insurance I ever had. They always covered everything we needed. Anthem was just the worst, and I suspect that some of my wife's health issues went undiagnosed for a while because of them gumming up the works, but the only evidence I have is that when we got new insurance, suddenly the doctors started figuring things out. It may have just been a coincidence, but I do know that Anthem always did make things difficult.

#6 | Posted by LEgregius at 2017-12-12 09:48 AM | Reply

"If her parents really cared, they'd go to medical school and become surgeons and perform the operation themselves. No one wants to be self-reliant anymore."

Not funny. Sort of disgusting that you think a joke is appropriate here. But then you are who you are and probably just don't know any better.

#7 | Posted by danni at 2017-12-12 09:57 AM | Reply | Newsworthy 3

Boo Hoo.

#8 | Posted by visitor_ at 2017-12-12 10:16 AM | Reply

Boo Hoo.

#8 | Posted by visitor

I'll visit you in hospice.

#9 | Posted by Zed at 2017-12-12 10:29 AM | Reply

Oh. Do hope you've got enough saved to pay for hospice.

#10 | Posted by Zed at 2017-12-12 10:30 AM | Reply

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Boo Hoo.

#8 | POSTED BY VISITOR_

If she didn't want to suffer and die, she should have been born rich, right? Isn't that the Republican motto?

Or was it, we don't want the government between a patient and their doctor to ensure people are covered. We'd rather let the insurance companies deny you.

#11 | Posted by Sycophant at 2017-12-12 10:31 AM | Reply

"If she didn't want to suffer and die, she should have been born rich, right? Isn't that the Republican motto?"

I'm just curious why you think the outcome would have been any different had this occurred in Canada or the UK. Socialized healthcare has never meant that you get any procedure you want, regardless of cost or consequence.

#12 | Posted by madbomber at 2017-12-12 10:34 AM | Reply

"These insurers do this and worse on a daily basis. Too bad they have so many poor, sick rwingers keeping them in bidness by voting Republican."

Right. And when Obama was president, Aetna wasn't doing this to anybody.

You would think that were true because articles like this stopped being posted here the minute Obamacare was passed.

Now that it's being threatened....back to articles like this as if Aetna stopped denying claims of this nature at any time.

#13 | Posted by eberly at 2017-12-12 10:54 AM | Reply

Socialized healthcare has never meant that you get any procedure you want, regardless of cost or consequence.

Is this classified as a cosmetic or elective procedure?

If it was, why didn't Aetna deny it on those grounds?

Because you're talking out your ass like a good corporate shill, that's why.

#14 | Posted by jpw at 2017-12-12 10:58 AM | Reply

"Is this classified as a cosmetic or elective procedure?"

It was classified as an experimental procedure...which is why it was denied.

"Because you're talking out your ass like a good corporate shill, that's why."

Did you not read the article? You should have. You wouldn't bee looking so stupid right now.

#15 | Posted by madbomber at 2017-12-12 11:18 AM | Reply

Expect to see more of these "my insurance won't pay for my treatment" stories along with "I couldn't afford my insurance anymore" stories next year. Lots of folks are going to rue the day they voted for Donald Trump. The rest of us already do.

#16 | Posted by Gal_Tuesday at 2017-12-12 11:36 AM | Reply

'Screw You. Aetna' -- Teen Girl Denied Brain Surgery
Sarah Palin's death panel, live and in color.

#17 | Posted by Hans at 2017-12-12 11:40 AM | Reply

I'm just curious why you think the outcome would have been any different had this occurred in Canada or the UK. Socialized healthcare has never meant that you get any procedure you want, regardless of cost or consequence.

#12 | POSTED BY MADBOMBER AT 2017-12-12 10:34 AM | REPLY

Who should be making the decision of where the line is?

Fine we can agree infinite care isn't possible. When a young woman needs a procedure to live a somewhat normal life, who decides?

Aetna or a doctor?

The rest of the world is passing us by. They pay less and have better outcomes.

#18 | Posted by hatter5183 at 2017-12-12 12:01 PM | Reply | Newsworthy 2

It was classified as an experimental procedure...which is why it was denied.

According to the insurance company, not any of the experts cited or the FDA.

Did you not read the article? You should have. You wouldn't bee looking so stupid right now

Says the guy who apparently didn't read the article.

Or is just shilling for a corp, as usual.

#19 | Posted by jpw at 2017-12-12 12:12 PM | Reply | Newsworthy 1

- Boo Hoo.

Were anyone to have ever doubted the disingenuousness of that poster, they no longer have any reason to do so.

- It was classified as an experimental procedure...which is why it was denied.

I just don't know who to buh-lieve, the FDA and the Mayo Clinic or MythBomber.

#20 | Posted by Corky at 2017-12-12 12:26 PM | Reply

"The rest of the world is passing us by. They pay less and have better outcomes."

But again, you seem to be presupposing that this is a decision that would have been made differently under a socialized system. if anything, I would submit that a socialized system would be more restrictive on experimental procedures than a commercial one, given that socialized systems tend to be less accommodating to specialized procedures unless there is some sort of supplemental insurance involved.

"According to the insurance company, not any of the experts cited or the FDA."

And it's the insurance company who pays for the claim...

"I just don't know who to buh-lieve, the FDA and the Mayo Clinic or MythBomber."

How about Aetna. They're the ones who classified it as experimental.

#21 | Posted by madbomber at 2017-12-12 12:40 PM | Reply

I mean, why else would they deny the procedure?

#22 | Posted by madbomber at 2017-12-12 12:41 PM | Reply

Because they don't want to pay the $300,000 it costs, obviously.

#23 | Posted by Corky at 2017-12-12 12:44 PM | Reply | Newsworthy 1

"According to the insurance company, not any of the experts cited or the FDA."

you mean "according to the language in the policy".

None of the experts agreed the policy language justified the denial? then these folks have a strong case against Aetna. But what experts? the FDA can discuss the experimental nature of the procedure but they can't read an insurance policy.
I'll tell you this....most denials are per specific policy language that justifies the denial. It sucks and it's mean it's wrong but if the language is clear then usually the denials hold up. However, if the policy is NOT clear...then the insureds have a strong case against Aetna.

I don't do benefits but I'd love to read the policy specifically the part of the policy Aetna is referencing to justify the denial.

#24 | Posted by eberly at 2017-12-12 01:09 PM | Reply

"Because they don't want to pay the $300,000 it costs, obviously."

Yeah. Obviously.

That's why Aetna DID AUTHORIZE the more expensive procedure.

You're starting to sound like JPW, which means you're starting to sound like some sort of unthinking progressive bot programmed to hit all the prevailing left-wing touch points.

Again...you should read the article.

#25 | Posted by madbomber at 2017-12-12 01:18 PM | Reply

"I don't do benefits but I'd love to read the policy specifically the part of the policy Aetna is referencing to justify the denial."

According to Aetna, "Clinical studies have not proven that this procedures effective for treatment of the member's condition."

The article also mentions that the Laser Ablation has a much lower success rate than the more traditional Temporal Lobectomies. It doesn't sound to me like Aetna was out of line at all...despite the usual handwringers trying to show otherwise.

#26 | Posted by madbomber at 2017-12-12 01:25 PM | Reply

"I'll tell you this....most denials are per specific policy language that justifies the denial. It sucks and it's mean it's wrong but if the language is clear then usually the denials hold up. However, if the policy is NOT clear...then the insureds have a strong case against Aetna. "

You do know there is a whole industry based on just rebilling insurance companies for denials, that they use programs like Access to pull out codes and such which insurance companies play games with. My daughter worked for such a company, in one year they collected over $5 million for just one hospital.

#27 | Posted by danni at 2017-12-12 01:27 PM | Reply

I'm just curious why you think the outcome would have been any different had this occurred in Canada or the UK.

I'd prefer that the decision be made by an agency tasked with providing people healthcare, not by a private corporation whose sole goal is to earn a profit for its shareholders.

That said, who am i kidding? Even if the US did pass medicare for all, pedophiles like Roy Moore would defund it at every opportunity and force it into a position of being unable to provide surgeries like the one in the article.

#28 | Posted by JOE at 2017-12-12 01:28 PM | Reply

The total cost could easily be more considering recovery time.... if you read the article.

"Van Gompel said a temporal lobectomy carries a much higher risk of serious complications, including the possibility of death. "It's a big jump to go to a big invasive procedure," he said.

Recovery time after open brain surgery can range from six to 12 weeks. By contrast, a patient who undergoes laser ablation can be back to work or at school in less than two weeks. The pain from laser surgery is much less, and extreme headaches are fewer than with open brain surgery, Van Gompel said."

#29 | Posted by Corky at 2017-12-12 01:31 PM | Reply

"I'd prefer that the decision be made by an agency tasked with providing people healthcare, not by a private corporation whose sole goal is to earn a profit for its shareholders."

The only difference is an accounting process that seeks to maximize benefits for the taxpayers versus maximizing profits for the shareholder. And if you had read the article, you'd know that Aetna authorized a more expensive traditional procedure of a cheaper experimental one.

The US has far more specialists than the UK. In order to see a specialist, you need a recommendation from a doctor. That specialist then has to agree to see you. How fast that specialist sees you depends largely on how much he or she benefits. If the Doctor is getting paid under the NHS...it'll likely be months. If you have supplemental insurance, you'll be seen within the week.

I know that USans want to imagine that a socialized healthcare system is one that simply responds to all wants and needs...all cost free...but that's not the case. Or at least it has yet to be the case. The NHS still has the same concerns as Aetna at the end of the day.

#30 | Posted by madbomber at 2017-12-12 01:36 PM | Reply

#29

A shorter recover time doesn't really matter if the procedure is less effective. In this case 50% versus >70%.

#31 | Posted by madbomber at 2017-12-12 01:36 PM | Reply

The NHS still has the same concerns as Aetna at the end of the day.

Largely due to the second paragraph of my post, which you predictably didn't read.

#32 | Posted by JOE at 2017-12-12 01:53 PM | Reply

I'd love to read the policy specifically the part of the policy Aetna is referencing to justify the denial.

#24 | POSTED BY EBERLY

Not sure what it says either but I am sure it favors Aetna's profits over the insured's health.

And obviously this girl has not lived her life right or she would have never gotten sick in the first place.

#33 | Posted by donnerboy at 2017-12-12 02:05 PM | Reply

A longer recovery time matters if one is comparing total costs... and if the bottom line is one's major concern as it is with insurance corporations.

The idea that they are more concerned with outcomes than costs is pretty funny, and something you just made up.

#34 | Posted by Corky at 2017-12-12 02:12 PM | Reply

How about Aetna. They're the ones who classified it as experimental.

Shills gotta shill.

It's probably considered experimental because it has a lower efficacy rate than a lobotomy.

They'd rather put the girl through more pain and suffering and expose her to more risk because God knows they don't want to pay for a lobotomy if the laser surgery doesn't work.

Or they could be the first medical insurance company ever to have compassion. I guess it's 50/50 as to which one it is.

#35 | Posted by jpw at 2017-12-12 02:32 PM | Reply | Newsworthy 1

"How about Aetna. They're the ones who classified it as experimental."
Shills gotta shill.
It's probably considered experimental because it has a lower efficacy rate than a lobotomy.
They'd rather put the girl through more pain and suffering and expose her to more risk because God knows they don't want to pay for a lobotomy if the laser surgery doesn't work.
Or they could be the first medical insurance company ever to have compassion. I guess it's 50/50 as to which one it is.
#35 | Posted by jpw at 2017-12-12 02:32 PM | Reply | Flag:
| Newsworthy 1

Other laser procedures have higher success and immediate recovery rates, in fact. Laser surgeries are replacing their other, more expensive practice that invent life-long dependencies, so represent a serious decline in medical costs which impact the masses that insurers control. AETNA doesn't want to let go control of money.

Why isn't marijuana used in the United States for even experimental medical therapies? They didn't own the crop, no money.

Throughout "therapy" these doctors at the behest of insurers will test their patients to verify they are not illegally getting help from marijuana.

Money witches, the lot.

#36 | Posted by redlightrobot at 2017-12-12 03:02 PM | Reply

"You do know there is a whole industry based on just rebilling insurance companies for denials, that they use programs like Access to pull out codes and such which insurance companies play games with. My daughter worked for such a company, in one year they collected over $5 million for just one hospital."

I think that's mostly due to codes, as you mentioned. Not stuff like this. If your point is that insurance companies are --------, fine.

But a lot of providers lie and cheat when submitting claims....to both insurance carriers and medicare.

#37 | Posted by eberly at 2017-12-12 03:20 PM | Reply

"I mean, why else would they deny the procedure?"

Take your MBA.
Wipe your ass with it.
There's your answer.

#38 | Posted by snoofy at 2017-12-12 03:29 PM | Reply

Corky and JPW, is laser ablation for seizures covered by medicare?

#39 | Posted by PinkyanTheBrain at 2017-12-12 05:34 PM | Reply

That's why Aetna DID AUTHORIZE the more expensive procedure.

#25 | POSTED BY MADBOMBER

Actually its because the family won't take the far more expensive, invasive procedure a good chunk of the time. Especially if it involves the family paying a chunk of the medical bill....and say cutting off a good chunk of your daughter's skull.

#40 | Posted by Sycophant at 2017-12-12 06:27 PM | Reply

the insurance cos must go.

#41 | Posted by ichiro at 2017-12-12 07:11 PM | Reply

"Take your MBA. Wipe your ass with it. There's your answer."

Another...um "shill" who didn't read the article...I know, I know..Shill is JPW's word. I need to come up with my own term for left-wingers who make comments without thought. How does stooge sound?

...Anyway, I know you didn't read the article because, if you had, you'd know that Aetna did authorize the more expensive procedure...the one with a higher probability of success. They made the rational choice. I get that as a progressive, rationality is not really your thing.

"Actually its because the family won't take the far more expensive, invasive procedure a good chunk of the time. Especially if it involves the family paying a chunk of the medical bill....and say cutting off a good chunk of your daughter's skull."

Instead they want a lower cost procedure that offers a significantly lower rate of success.

What do you think Aetna should do if the parents wanted to send her to a witch doctor in return for thousands of dollars?

#42 | Posted by madbomber at 2017-12-12 08:43 PM | Reply

"But a lot of providers lie and cheat when submitting claims....to both insurance carriers and medicare."

Yeah. Spun another way, progressives could have easily characterized this as unnecessary and costly care that was just going to drive up medical costs even higher.

#43 | Posted by madbomber at 2017-12-12 08:44 PM | Reply

Everything that is a natural monopoly should be operated in the best interests of the public. This creates the most competitive organization for any country in a global marketplace. Internet access, education, water, sewer, electricity, roads, bridges, mail and health care are all natural monopolies.

#44 | Posted by bayviking at 2017-12-12 09:25 PM | Reply | Newsworthy 1

- Instead they want a lower cost procedure that offers a significantly lower rate of success.

Merely repeating the lie without addressing the points made in rebuttal in 34 and 35 makes you look quite disingenuous.

So, a true reflection.

#45 | Posted by Corky at 2017-12-12 10:24 PM | Reply

Corky and JPW, is laser ablation for seizures covered by medicare?

#39 | POSTED BY PINKYANTHEBRAIN

Good question.

I've been digging a bit and have found that there's about six names for this technique and it's used for treating various cancers as well.

In other words, a lot of false leads on an answer thus far.

#46 | Posted by jpw at 2017-12-12 10:58 PM | Reply

There's got to be a way to work experimental surgery out maybe an agreement between government and insurance. But I have to say the reason my drivers license says I'm an organ donor is because of experimental surgery. Had one myself though it was just a bone injury. My surgeon brought all his colleagues in to see the results. He was pretty happy.

#47 | Posted by bruceaz at 2017-12-12 11:02 PM | Reply

Look what I did, look what I did ,lol.

#48 | Posted by bruceaz at 2017-12-12 11:03 PM | Reply

#46 I looked and couldn't find the answer to my question either.

Was also pondering.... So what health insurance company does cover this specific procedure for this specific reason?... Ran into a dead end on that also, only way to find out would be to actually call insurance companies to find out... Which I feel this reporter should have done, would have made a much stronger case.

#49 | Posted by PinkyanTheBrain at 2017-12-13 01:07 AM | Reply

"Merely repeating the lie without addressing the points made in rebuttal in 34 and 35 makes you look quite disingenuous."

I am literally stating what was presented in the article. The fact that you disagree is, well, meaningless.

#50 | Posted by madbomber at 2017-12-13 03:22 AM | Reply

"Actually its because the family won't take the far more expensive, invasive procedure a good chunk of the time. Especially if it involves the family paying a chunk of the medical bill....and say cutting off a good chunk of your daughter's skull."
Instead they want a lower cost procedure that offers a significantly lower rate of success.
What do you think Aetna should do if the parents wanted to send her to a witch doctor in return for thousands of dollars?

#42 | POSTED BY MADBOMBER

Are Witch Doctors recognized as standard procedures for treatment by the FDA? No?

Well the less invasive surgery this girl request is recognized as such.

So yeah, they want to try the less invasive surgery with the lower success rate first rather than cutting off the top of their daughter's skull. Can you blame them?

#51 | Posted by Sycophant at 2017-12-13 11:32 AM | Reply

#46 I looked and couldn't find the answer to my question either.
Was also pondering.... So what health insurance company does cover this specific procedure for this specific reason?... Ran into a dead end on that also, only way to find out would be to actually call insurance companies to find out... Which I feel this reporter should have done, would have made a much stronger case.

#49 | POSTED BY PINKYANTHEBRAIN

Umm... You think you can just call insurance companies and ask if they cover this super rare procedure? Seriously?

#52 | Posted by Sycophant at 2017-12-13 11:33 AM | Reply

The problem we run into here is that when insurance companies refuse to cover experimental procedures, innovation comes to a screeching halt. Same effect with off-label medication uses. My wife has chronic severe nerve pain. There are pain medications and treatment techniques that she cannot get because the cause of her pain is not on the approved list.

#53 | Posted by hatter5183 at 2017-12-13 11:33 AM | Reply

#52 Yes Toady, I think the reporter should have called other insurance companies, to see if they covered it before putting Aetna on blast for not covering "this super rare procedure"(as you said).. . FYI that is the same thing the Dr's office did to see if it was covered.

Have you seriously never called an insurance company to see if something was covered?????? If you haven't, I'll consider you luckily blissful. If you have, well you can fill in the blank ___________!

#54 | Posted by PinkyanTheBrain at 2017-12-13 12:05 PM | Reply

""Actually its because the family won't take the far more expensive, invasive procedure a good chunk of the time. Especially if it involves the family paying a chunk of the medical bill....and say cutting off a good chunk of your daughter's skull.""

No, it's more like the insurance company realizes that there are enough lunatics like you to support any decision they make so that the public outcry will be less loud, less intimidating to them.

#55 | Posted by danni at 2017-12-13 12:12 PM | Reply

from the article we can once again see that madbomber is misleading:

Dr. Jamie Van Gompel, a neurosurgeon at the Mayo Clinic, disputes Aetna's assessment. He is not involved in Cara's care nor Rittereiser's treatment, but he said Aetna's assessment is wrong.

"I would not call it experimental at all," said Van Gompel, who is leading a clinical trial on the surgery at Mayo as part of a larger national study. "It's definitely not an experimental procedure. There've been thousands of patients treated with it. It's FDA-approved. There's a lot of data out there to suggest it's effective for epilepsy."

Van Gompel said a temporal lobectomy carries a much higher risk of serious complications, including the possibility of death. "It's a big jump to go to a big invasive procedure," he said.

Aetna's death panel is hard at work.

#56 | Posted by bayviking at 2017-12-13 06:12 PM | Reply

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