When Cara Pressman gets seizures, she describes it as "like having a nightmare but while you're awake," giving her the chills and the shakes and causing her to zone out for up to two minutes. So the 15-year-old, who a release says is from New York and has suffered from seizures since she was 9, was elated when she was set in October for a minimally invasive brain surgery called laser ablation that could end her trauma, per CNN. But just days before the procedure, it was canceled, because Aetna, the family's insurance company, denied the coverage, saying the surgery is "experimental" for epilepsy and "the effectiveness of this approach has not been established." Instead, Aetna approved a more expensive temporal lobectomy, despite laser ablation being FDA approved and a Mayo Clinic neurosurgeon saying the procedure is a well-regarded one.
"There's a lot of data out there to suggest it's effective for epilepsy," Dr. Jamie Van Gompel says. Plus, patients who have laser ablation recover more quickly than those who undergo traditional brain surgery—in less than two weeks, instead of up to three months—and have less pain and less risk of complications, per Van Gompel. "It's just so frustrating for us to know there's … a way to fix our daughter, and some bureaucratic machine is preventing this from happening," Cara's dad says. Her parents say while they're appealing, they'll consider dipping into their retirement funds and finding other means to pay for the $300,000 out-of-pocket cost. Cara's take to Aetna, six weeks and more than two dozen seizures later: "Considering they're denying me getting surgery and stopping this thing that's wrong with my brain, I would probably just say, 'Screw you.'" (Read more health insurance stories.)