Insurance Denies Teen Minimally Invasive Brain Surgery - Opposing Views

Insurance Denies Teen Minimally Invasive Brain Surgery

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A 15-year-old has a blunt message for the insurance company that denied to cover a minimally invasive surgery that could have put an end to her seizures.

"Considering they’re denying me getting surgery and stopping this thing that’s wrong with my brain, I would probably just say, ‘Screw you.’"

Cara Pressman, from New York, has complex partial seizures multiple times a week, according to CNN. The seizures can be triggered by nearly anything -- she can get them when she's stressed, when she's happy or when she exerts herself.

She describes the seizures as "having a nightmare but while you're awake," saying she will zone out for 20 seconds to two minutes while her body gets cold and shakes.

Cara, who has had the seizures since she was 9 years old, finally got the chance to possibly eliminate her seizures forever. She planned to have laser ablation surgery, a minimally invasive procedure where a thin laser is used to destroy lesions in the brain responsible for the seizures.

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But her dreams of a new life came crashing down when her parents informed her that their insurance company, Aetna, would not cover the procedure.

"When my parents told me, I went kind of blank and started crying," she said. "I cried for like an hour."

Her surgery was only three days away and Cara's friends were already lined up at the hospital in support. Through tears, Cara had to text them that the surgery was off.

Aetna is the country's third-largest health insurance provider, covering 23.1 million people. In denying the procedure, the company wrote to the Pressman family that it considers laser ablation surgery "experimental and investigational for the treatment of epilepsy because the effectiveness of this approach has not been established."

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It added: "Clinical studies have not proven that this procedures effective for treatment of the member's condition."

Instead, the company approved a more invasive and more expensive open brain surgery, called a temporal lobectomy.

Dr. Jamie Van Gompel, a neurosurgeon at the Mayo Clinic, who is not involved with Cara's treatment, has blasted Aetna's position on laser ablation surgery, saying that the procedure is safe.

"I would not call it experimental at all," said Van Gompel. "It's definitely not an experimental procedure. There've been thousands of patients treated with it. There's a lot of data out there to suggest it's effective for epilepsy."

In a statement to the Daily Mail, Aetna maintained that laser ablation was not safe or approved.

"It is never easy to tell an individual or family that a treatment or procedure is not approved," said the company. "However, effectiveness and member safety will always be the most important factors in determining our clinical policies."

Cara's parents are determined to pay for the $300,000 surgery out of pocket and have been thinking of dipping into their retirement funds, according to CNN.

Although they're appealing Aetna's decision, they're not hopeful.

"It's just so frustrating for us to know there's a solution out there -- a way to fix our daughter -- and some bureaucratic machine is preventing this from happening," said Cara's father, Robert Pressman. "You get so angry, but you don't know who to take it out on, because there's no particular person that's doing it. It's this big bureaucracy that's preventing this from happening."

Sources: CNN, Daily Mail / Featured Image: Pixabay / Embedded Images: Pressman Family via CNN, Handout via Daily Mail

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