Aetna shatters the life of a mother of two with their coverage policy

By: aetna
WILMINGTON, Del. - Dec. 12, 2017 - PRLog -- For Jennifer Rittereiser, a 44-year-old wife and mother of two young sons, May 5, 2017 is a date she will never forget.  That was the day she received a letter from Aetna denying her upcoming brain surgery to treat her epilepsy.  Jennifer has battled seizures since she was 10 and has been able to function with an array of medications for the last 34 years.  But in the past few years, the medication did not always work, and she began to experience more seizures.  She has what is knows as drug resistant temporal lobe epilepsy.

She was evaluated by an array of doctors and was ultimately admitted to an Epilepsy Monitoring Unit in Philadelphia for six days.  The stay involved surgical planning beginning with an office consultation with a neurologist, followed by 6 days of inpatient testing and observation. Diagnostic tools such as continuous EEG display, MRI, PET/CT scan, neuropsychological testing and fMRI (functional MRI) identify epileptogenic areas of the brain and allow the neurologists to map brain function.

The neurological team at the premier medical center, agreed that based on the outcomes of her stay in the Epilepsy Monitoring Unit and that medications were no longer controlling her seizures, she was an appropriate candidate for minimally invasive laser thermal ablation surgery.  Jennifer was so excited to hear this because the neurologists consider this surgery to be more precise and safer than traditional brain surgery that would involve cracking open the skull and removing a part of the brain.

In April of 2017, she lost consciousness after experiencing a seizure while driving her SUV with her 7-year old son Robert in the car.  Her SUV rammed into a car in front of her before veering into oncoming traffic.  Her vehicle then sped down an embankment, flipped over and came to rest on its side.  She narrowly missed slamming into a guardrail and several trees.  Somehow, Jennifer and her son managed to walk away unharmed.  "People were amazed," she said.  "They had a helicopter on the way." That's when she knew it was time to schedule the laser ablation surgery.  She was all set to have the procedure on June 16, 2017 until Aetna sent their denial letter.  They would, however, cover the more invasive and expensive open brain surgery that carries a higher risk of serious complications and recovery time.

It's hard to believe that Aetna, a major player in healthcare, would rather a surgeon split open a patient's skull and remove part of the brain to excise a small lesion that causes epilepsy.   For decades, that was the only option surgeons had to treat drug resistant temporal lobe epilepsy.   Thankfully, other minimally invasive surgical alternatives are now available.  Unfortunately, Aetna refuses to recognize this "innovative" "simple" surgery that better "focuses on patient's health" even though that is the corner stone of their core values (see below)!

"Innovation, Simplicity, focus on patient's health, Integrity, Excellence, Caring, Inspiration to make the world a better place"

Since 2008, the FDA approved a specific laser to ablate lesions in the brain that cause epilepsy.   The Epilepsy Foundation, among other leading experts in the field, recognize the benefits of laser ablation surgery over the traditional invasive lobotomy procedure.  The American Epilepsy Society states stereotactic laser ablation results in better cognitive outcomes in patients with temporal lobe epilepsy than treatment with standard open surgical approaches, researchers reported at the 67th Annual Meeting of the American Epilepsy Society in March of 2014.

The Mayo Clinic, considered one of the most premier hospital systems, lists the advantages for patients on their website.  They state "This minimally invasive laser procedure is rapidly becoming an excellent treatment option of patients with epilepsy.  Because laser ablation is minimally invasive, patients typically are hospitalized only overnight.   Many are ready to resume normal activates within two to three weeks.  Laser surgery can also lower the risk of damaging the patient's memory and language abilities".

The Congress of Neurological Surgeons has a division dedicated to this type of surgery called the American Society for Stereotactic and Functional Neurosurgery (ASSFN).  Members are from premier hospital systems that are performing this procedure in place of the more invasive traditional lobotomy.   The following is just a partial list of those facilities:

Mayo Clinic

University of Chicago Medicine

Cleveland Clinic

Massachusetts General

Emory Hospital

Texas Children's Hospital

Jefferson University Hospital

Robert Wood Johnson Hospital

Seattle Children's Hospital

Vanderbilt University Medical Center

Wake Forest Epilepsy Center

St. Louis Children's Hospital

So why won't Aetna cover the procedure being used by neurosurgeons throughout the country?  It's because they believe it is still "investigational and experimental".  They seem to know better than the experts in the field of neurosurgery!  When presented with copious amounts of evidence to the contrary, they state their "Coverage Policy Bulletin" says so!  And, they won't review the sacred "Coverage Policy Bulletin" for at least another year.

In the meantime, Aetna's coverage position is impacting 4 generations in Jennifer's family.  She shares just some of the struggles her family faces:

"My boys are very much impacted because their mother cannot drive them anywhere, so we are constantly relying on friends and Uber.  They worry if I am ok because I warn them to call 911 if I feel a seizure is coming.  My 7-year-old son has come into my bed every night since we were in the accident together.  My husband has been of huge support, but the constant worry is taking a toll on him.

For me personally, I experience horrible side effects of the medication and I live in fear of when will the medication stop helping to the extent it does now.  I also am depressed for having to rely on other people for so many things.  I worked hard to get where I am professionally - went to Columbia University for an MPH while working full time as a Nursing Home Administrator. Now I repeat myself during meetings or don't follow through on something because I am so forgetful on the meds.

My parents recently sold their home in NJ where they lived for 47 years in NJ to move to Delaware to be closer to help me.  My mother was one of the primary caretakes of my grand-parents, ages 95 and 96 both on home hospice in NJ and now the family has had to hire a full-time caregiver."  If I could just get the surgery my physicians have recommended I would get my life back!"

Aetna, it is time to do the right thing and "focus on patient's health" by covering this surgery that is the preferred method of treatment by premier hospital systems throughout the country!

Ellen Banks
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Tags:Aetna, Eplilepsy Surgery
Location:Wilmington - Delaware - United States
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Page Updated Last on: Dec 14, 2017

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