A metro Atlanta man says his insurance company refuses to pay for a life-saving surgery.
Jonathan Douglas, 49, used to walk seven miles a day as recently as a year and a half ago. Now, he has trouble just getting out to the mailbox of his Henry County home.
“I’ll get up and go to the bathroom and pass out on my living room floor,” Douglas told Channel 2 consumer investigator Justin Gray.
Doctors say the pumping strength of Douglas’ heart is at only 10-15%. He’s in congestive heart failure.
But there is a procedure his doctors at Emory Midtown Hospital say will have him back up and moving normally again.
It’s called a Barostim implant. It was FDA approved in 2019. The problem is his insurance company has denied coverage for the implant seven times now.
After a sixth denial, his doctors in Henry County sent him to Emory. There, a specialist once again scheduled the surgery. But Anthem Blue Cross Blue Shield denied coverage the day before.
Anthem wrote in his denial letter that it denied 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 the chemotherapy used to successfully battle leukemia.
“If the insurance company is going to deny me from 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 wit’s end now,” Douglas said.
Anthem sent us a statement, saying:
“This matter was reviewed in accordance with Anthem’s clinical guidelines, which rely on scientific evidence published in peer-reviewed medical literature and other factors that show a demonstrated benefit. Members are always afforded appeal rights, including external review with an independent review organization.”
“I have thought several times I’m nothing more than a racehorse that has a broken leg, and the horse trainer has decided to put me down and Anthem Blue Shield is my horse trainer,” Douglas said.
The cost of the procedure without insurance is more than $250,000.