Dear Appeals People at Blue Cross Blue Shield of North Carolina

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