Disability by Denial: Need help:Blue Cross Rejects Critical Surgery for Orange County ICU Nurse

[caligirl]

I got this alert from CNA today and would like to ask any interested person to take action as instructed in this press release.

For Immediate Release
March 6, 2008



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Disability by Denial: Blue Cross Rejects Critical Surgery for Orange County ICU Nurse

Woman Possibly Left Disabled by Denial

Nurses Launch Online and Telephone Campaign to Flood Blue Cross With the Message: Save Our Colleague

Nurses from around the country have vowed to take up the case of 46-year-old Kim Kutcher, RN, as she battles Blue Cross and its decision to sentence her to a possible lifetime of disability by denying her back surgery that doctors and nurses believe is critically important.

The California Nurses Association/National Nurses Organizing Committee have put out a call to flood to flood Blue Cross' office with calls and faxes, in an urgent appeal to the insurance company to overturn its decision and save the health of their colleague. They will be joined in the effort by other patients, friends, and family of Kutcher from Orange County, as well as advocates for the kind of "Medicare for all" healthcare that would end the ability of health insurance corporations like Blue Cross from making life-and-death decisions like this one.

Kutcher has degenerative disc disease — related to her years of nursing — and her neurosurgeon recommends an artificial disc to solve the problem, and allow her to return to work as a critical care nurse. Calling the procedure "investigational," despite the FDA’s approval of it, Blue Cross is instead pushing a different high-risk procedure that will fuse two of her discs together. She is scheduled once again for the surgery on March 11 and plans to go through with it even if it means paying out of pocket and losing her home.

To join in, please:

Call:
(818)-234-6063 Yvette Ambeguia, case manager
(818)-234-3095 Theresa Peterson, supervisor
[phone] Corporate Blue Cross

Fax:
[phone] Blue Cross of California
[phone] National Corporate Office

"I am getting this procedure because I want to get back to work as a critical care nurse. I have been on state disability for nine months and I am in severe pain," said Kutcher. "I have grave doubts about my chances to return as an RN if I have the procedure recommended by Blue Cross, which is spinal fusion. I have been unable to find a single nurse who returned to work after fusion complications."

Kutcher noted the strong possibility of age bias in this decision, as the treatment she seeks has recently been approved for a 26-year-old friend. "So for one person, the surgery is 'investigational' and for another not?," asked Kutcher.

"Ironically, Blue Cross has been running radio ads touting the money they have donated to produce more nurses in California," said Geri Jenkins, an RN who works at UC San Diego and is one of four elected CNA/NNOC presidents. "Kim Kutcher is a trained critical care nurse and they won't even pay for the surgery she needs that will return her to work in a profession that is desperate for experienced RNs. This is not a humane system, and any reforms that reinforce and reward those who profit off pain and suffering will not end our national healthcare nightmare."

There is another approach, a single-payer system, similar to expanded and improved "Medicare for all." Similar approaches are succeeding in nearly every other nation, by replacing for-profit insurance with national, universal, nonprofit coverage. These proposals provide better health results at a much lower cost—and take the Blue Crosses of the world completely out of the equation. HR 676, by Rep. John Conyers is one such system, and features 87 cosponsers in the U.S. Congress.

Background on Kutcher case:

Back in May, Kutcher was running five to six days a week, enjoying life, working as a nurse in an intensive care unit — an occupation she loves — and doing the normal day-to-day things a mother of four children does.

"I am sick and tired of Blue Cross," said Maree Kutcher, Kutcher's 17-year-old daughter. "When I hear their commercial anywhere, I turn it off. Blue Cross is taking away my mother's life. I will do anything to get it back."

"I miss my life. That is why I am going forward with the disc replacement procedure, which is less invasive, has easier recovery, and gives me a quicker return to work. I cannot live one more day like this. I worry about my general health and wonder what the stress of this ordeal will do to me in the long run. I never wanted surgery, and did everything I could to avoid it."

Disc replacement, a proven treatment, was FDA approved in 2004. The first disc replacement in the US goes back to 1998, and has been the preferred treatment for degenerative disc disease in Europe since 1984. Among the insurance companies that cover ADR surgery are Aetna, Cigna, Kaiser, and worker’s compensation.
http://www.calnurses.org/media-center/press-releases/2008/march/disability-by-denial-blue-cross-rejects-critical-surgery-for-orange-county-icu-nurse.html

[jody]

1. Fwd. to the nurses in my family. n/t

[kestrel91316]

2. Blue Cross is pure evil.

[Midlodemocrat]

8. No, they aren't. The plans are specific to how much the company is willing to pay.

High end or low end. There is a product for everyone. It's NOT the insurer. It's the company.

[Rosemary2205]

3. Why is this going through Blue Cross and not worker's comp????

"Kutcher has degenerative disc disease — related to her years of nursing"

[caligirl]

5. We asked that too, I have no answer. Thought it might be worth asking

the CNA rep about tomorrow when they are back in their offices.

[walldude]

4. You'd think after CIGNA let that girl die over a liver transplant

that insurance companies would take notice. I guess when it's your job to decide just how much money a human life is really worth you become a complete asshole.

[warren pease]

6. Have you or the CNA forwarded this to Michael Moore, PNHP ...

CA Insurance Commissioner Steve Poizner (really), CA attorney general Jerry Brown, sympathetic investigative reporters (any of the three still trying to work in the continental US), consumer advocates and as many progressive blogs as possible?

Also, have you (or the CNA) considered organizing a nurses' sit-down strike throughout Southern Calif. until BC decides they can't handle the bad PR and caves?

If you consider the strike option and have a free 15 minutes or so, it might be helpful to read up on the Woolworth's sit-down strike of 1937. Here's links to parts one and two of an article entitled "They Won, and They Won Big: The Woolworth Strike of 1937."

Good luck. I hope the bastards cave so that a) Kim Kutcher gets the surgery she needs, and b) they eat yet another dose of the poison that's eventually going to kill off all these parasites who operate legalized medical protection rackets, which is all this miserable, profits-over-people excuse for a health care system really is.


wp

[Midlodemocrat]

7. She needs to appeal through her COMPANY and not Blue Cross.

Insurance coverage is based upon the plan the COMPANY chooses, not the specific insurer. You can have 'Blue Cross' (for example) and it can be the best or worst coverage known to man based on the plan the COMPANY chooses.

She needs to appeal to whoever in her company dealt with selecting BCBS in the first place. TRUST ME. I know of what I speak. If the company will okay it, the insurance company will pay it.

[WillowTree]

9. Forget the Chicago (312) numbers.

Those are for the BCBS Association, which has little or nothing to do or say about benefit determinations made by the individual, independent BCBS companies.

BCBS of California is a for-profit company owned by Wellpoint. You would stand a much better chance of making a point by contacting them.