New York mom faced a $27K bill after Aetna denied her 9-year-old son's surgery as 'cosmetic' — how she fought back

详细摘要

Caring for a sick child with a rare medical condition is stressful enough. But Brooklyn resident Nadine Friedman also found herself stuck with a $27,000 surgery bill — despite…

Caring for a sick child with a rare medical condition is stressful enough. But Brooklyn resident Nadine Friedman also found herself stuck with a $27,000 surgery bill — despite having insurance.

Friedman's 9-year-old son, Ozzie Roberts, has Goldenhar Syndrome, a congenital condition that results in bones and muscles forming improperly on a child's face. For Roberts, it resulted in problems with his right ear, including pain, redness and growth issues.

"A lot of the nights during the week, just midway through the night, [he was] just crying, screaming," Friedman told CBS. "It was really tough to see."

Roberts received surgery to fix his ear — but Friedman's insurance provider, Aetna (which is owned by CVS Health), wouldn't cover the cost. That left Friedman's family stuck with almost $30,000 they shouldn't have had to pay.

Here's how Friedman successfully got Aetna to pay for the surgery — and what you can do if you're facing an insurance bill you feel should have been covered.

Roberts got ear-pinning surgery, a procedure that involves moving someone's ears closer to their head. It's a form of plastic surgery that some people get to improve their appearance. But for Roberts, the surgery was medically necessary.

Aetna still denied the claim, saying the procedure was cosmetic. Friedman appealed the decision and was again denied, even though Roberts' doctors wrote Aetna telling them the surgery was needed.

"I would absolutely never do anything like this unless it absolutely impeded on his health and his life," Friedman told CBS.

Aetna told CBS that Roberts' "original submitted billing code is typically for coverage of a cosmetic procedure and warranted further review."

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