Blue Cross Blue
Shield of North Carolina
Appeals
Department
Level 1
P.O. Box 30055
Durham, NC 27702
RE: Denial of
benefits (reference #: ZE-140429)
13 August 2016
Dear Blue Cross
Blue Shield of North Carolina:
On October 25,
2013, at the age of 43, I had a massive myocardial infarction that nearly
killed me, did irreversible damage to my heart, and caused me acute
psychological distress, which manifested itself as PTSD, depression, and
anxiety. After receiving conflicting
medical diagnoses from two cardiologists in North Carolina (neither of which
was a women’s heart expert), I sought at third opinion from women’s heart
specialist Dr. Sharonne Hayes at the Mayo Clinic, where I was definitively
diagnosed with Spontaneous Coronary Artery Dissection (SCAD), a genetic disorder
that causes often fatal and spontaneous shredding of the lining of the
arteries.
SCAD
predominantly affects healthy women with no risk factors whatsoever – I am a
long distance runner, non-smoker, long-time vegetarian, for example – and has
only recently been studied, in large part because of discriminatory preexisting
assumptions and attitudes about women and heart disease/attack. For my heart, I take a low dose ace
inhibitor, which takes some of the stress off of my damaged heart and allows
the healthy part of my heart not to work as hard, and a daily low-dose
aspirin. For my anxiety, depression, and
PTSD, along with seeking psychological therapy, I have tried Zoloft, Prozac,
and Lexapro, with varying degrees of success.
At my annual
physical in July of this year, I discussed with my doctor, Laurie LeMauviel, my
continued struggles with the physical and psychological aspects of my heart
attack; I don’t believe that the mind and body can be disaggregated and
disengaged from one another, and I remain troubled that Western medicine (and
Western insurance – even after the Affordable Care Act did significant work to
address that issue) consistently refuse to recognize that treatment of one
necessarily impacts the other. My blood
work indicated the my B12 levels were very low, and, given my battles with
depression and anxiety and my seeming inability to find the correct medication
to help me with those, Dr. LeMauviel suggested genetic testing for variants in
my MTHFR. Two
abnormalities were diagnosed after this testing, and my knowledge of those
abnormalities and their implications is absolutely medically necessary. Here’s why:
The variations
noted (677T and 1298C) are responsible for several factors that impact both my
physical and mental health. First, these
variants are responsible for my body’s inability to properly absorb certain B
vitamins, primarily B6 and B12, and this lack of absorption is probably the
cause of some of my struggle with depression and anxiety. Second, low levels of B vitamins contribute
to elevated levels of homocysteine in the blood, which have been directly
linked to increased risk for heart attack – including SCAD related heart
attack. This test may very well save my
life.
I am concerned
that this denial of benefits for this testing as “not medically necessary” is
based on a failure to understand or appreciate the value of mental health in
the service of physical health and vice versa.
Further, since being diagnosed with SCAD, I have been as vocal an
advocate as possible for increased understanding and study of the ways that
women have heart attacks, why women have heart attacks, and how the medical and
insurance communities can more appropriately and responsibly respond to women’s
heart attacks. It is my sincere hope
that this letter will do some positive work in the service of the
discrimination that women have long faced, from medical providers and from insurers,
with regard to heart and mental health.
Sincerely,
Laura Wright
Cc: Wayne
Goodwin, NC Commissioner of Insurance
