Minutes before her 10-hour surgery, Olivia Olsen is feeling confident. >> I think I look beautiful and I don't really care what other people think of me. >> The 8-year-old was born with Micros, a rare condition that meant her left ear fully developed. >> I just want to get a big ear so people don't bully me in the future. >> Next thing you know, you'll be waking up. Her parents, Annie and Dave, knew since birth Olivia would need an operation to reconstruct her ear. >> We had no doubt in our minds that the i ...

Healthcare & Insurance Industry Challenges - A family faced denial of coverage for their daughter's microtia surgery by Anthem Blue Cross Blue Shield, due to the specialist being out-of-network [1] - The insurance company initially denied a gap exception, which would have allowed the family to use in-network benefits for an out-of-network provider [1] - The family had to borrow money, use credit cards, and withdraw funds from a 401(k) retirement account to cover the approximately $100,000 surgery cost [1] Insurance Coverage Resolution - Following inquiries from NBC News, Anthem approved coverage for the surgery by the out-of-network specialist, Dr Cheryl Leuen, while the surgery was already underway [1] - Anthem stated that they made a "unique one-time exception" to ensure the child's care was not delayed, despite the plan typically not covering out-of-network providers when an in-network provider is available [1] Patient Outcome - The 8-year-old patient, Olivia Olsen, underwent successful ear reconstruction surgery for microtia [1][2] - Olivia will need approximately one year to fully heal and will also require a hearing implant [2]

Healthcare Coverage & Insurance Disputes - Aetna initially denied coverage for a 68-year-old man's spinal reconstruction surgery, despite his doctor's recommendation [3][4] - The denial was partly based on the patient not completing physical therapy, which the doctor deemed ineffective for his condition [4] - The insurance company reversed its decision and approved the surgery after NBC News contacted them [6] - Aetna claimed the patient's doctor had opportunities to engage with their medical team but declined, and that necessary documentation was not previously provided [6] - The patient disputes Aetna's claim about the information and the doctor declined to comment [7] - The denial of coverage resulted in the patient losing approximately one year of normal life [7] Patient Experience & Impact - The patient experienced severe back pain that significantly impacted his daily life and activities [2] - The patient sought various methods of pain relief, including a human dog bed [2] - The patient's family expressed frustration and helplessness due to the denial of necessary medical treatment [5]

Healthcare & Insurance Industry Focus - A family's insurance company, Blue Cross Blue Shield, is denying coverage for a potentially life-saving gene therapy (Levitus) for one son with Duchenne Muscular Dystrophy (DMD), while covering it for another son with the same diagnosis [1][5] - Levitus, a state-of-the-art gene therapy, costs $3.2 million [4] - Blue Cross Blue Shield declined to discuss the specifics of the case, citing patient privacy, but stated its decisions are guided by nationwide best practices [6] - The FDA is scrutinizing Levitus after two boys died after receiving it, though their DMD was advanced [7] Duchenne Muscular Dystrophy (DMD) - DMD is a genetic disorder that progressively attacks a person's muscles, typically leading to wheelchair use around age 12 and a life expectancy of under 30 years [2] - The gene therapy, Levitus, has shown to slow DMD's progress [4] - DMD causes muscle weakness and fatigue, with scar tissue layering on larger calf muscles [3] - The family emphasizes the urgency of treatment, as the son's condition is deteriorating rapidly [8]