Mansell, Engel & Cole

Aetna's coverage rejection scorned by legion of critics

A teen-aged girl living with epilepsy-linked seizures had high hopes a couple months ago in the days immediately preceding scheduled surgery to relieve her of her life-altering symptoms.

Her procedure -- minimally invasive surgery called laser ablation -- has a string of documented successes in persons with epilepsy. A recent CNN article on the surgery states it is "safer and more precise than traditional brain surgery."

Moreover, laser ablation is strongly endorsed in the medical community. One prominent Mayo Clinic neurosurgeon says that a high number of patients have been successfully treated with it and that there is "a lot of data out there to suggest it's effective for epilepsy."

Notwithstanding the accolades and corroborative clinical evidence that backs laser ablation, though, one solitary voice continues to strongly resist its use in epilepsy seizure cases.

That is mega-insurer Aetna, which refused to provide coverage for the above-cited teen's ablation procedure. Aetna calls the surgery "experimental and investigational for epilepsy" and contends that studies to support it are too limited to be useful.

Such comments have reaped scorn from the Epilepsy Foundation, which flatly refutes them. One scientific principal with the foundation calls laser ablation a "best-suited" procedure for symptomatic seizures. And the foundation's president laments insurance denials, which he says are misplaced and tragically common.

"You get so angry," says the father of the teen denied coverage. He points to "this big bureaucracy that's preventing this from happening" as the chief catalyst promoting unfair outcomes.

The sad reality is that insurance denial is indeed a commonplace across the United States. Adversely affected individuals and their families can contact a proven pro-policyholders' law firm for knowledgeable and aggressive representation in any insurance-related matter.

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