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HealthMay 27

Insurer reverses denial of brain surgery for teen with severe epilepsy after media inquiry

Anthem Blue Cross Blue Shield changed its coverage policy for pediatric brain surgery after NBC News inquired about a denied claim for a 13-year-old with daily seizures.

Synthesized from 2 sources

A 13-year-old Illinois girl who suffers from up to four seizures daily had her insurance company reverse its denial of coverage for brain surgery after a news outlet inquired about her case.

The teenager's doctor had recommended deep brain stimulation surgery as a potential treatment for her severe epilepsy after multiple medications failed to control her condition. Anthem Blue Cross Blue Shield initially denied coverage for the procedure.

NBC News reached out to the insurance company about the denial as part of its investigative series examining insurance claim denials. Several weeks after the media inquiry, Anthem reversed its decision in this specific case.

The insurer also announced a broader policy change, expanding coverage of deep brain stimulation procedures to include certain pediatric patients. Previously, the company's policy had more restrictive criteria for covering the surgery in children.

Deep brain stimulation involves implanting electrodes in specific areas of the brain to help control seizures in patients with treatment-resistant epilepsy. The procedure is considered when traditional medications prove ineffective at managing the condition.

The case highlights ongoing disputes between patients, doctors, and insurance companies over coverage for specialized medical procedures, particularly those involving newer or less common treatments for pediatric patients.

Sources (2)

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