Watch full video here.
By Justin Gray, WSB-TV —
HENRY COUNTY, Ga. — A Henry County man says a groundbreaking heart surgery changed his life and likely saved his life.
But it’s a procedure his insurance company repeatedly denied.
Channel 2 consumer investigator Justin Gray first spoke to Jonathan Douglas nearly a year ago when he was fighting that insurer.
Even after our Channel 2 Action News story aired, Anthem Blue Cross Blue Shield continued to deny the surgery.
So Douglas turned to friends and family for help. Now he wants to help others doing battle with their insurance companies know their rights.
Douglas now takes a walk around his henry county neighborhood every day.
“I’m up to over three miles a day now walking,” Douglas said.
But when Gray spoke with Douglas in May of 2022, he could barely make it to the mailbox and was unable to leave the house because he was in congestive heart failure.
His heart was only pumping at about 10% to 15%.
“I can’t tell you how many times my family found me passed out here or in the hallway,” Douglas said.
His life-changing recovery is thanks to a surgery to insert something called a Barostim Implant.
It’s a procedure his insurer, Anthem Blue Cross Blue Shield, denied nine times with repeated appeals before he finally raised the money himself through a GoFundMe page.
That’s why Liz Coyle from the consumer advocacy nonprofit Georgia Watch says Georgians need to know they can file what’s called an external appeal even if they are denied by their insurer.
“That’s the point at which we really encourage the consumer who’s involved to take it to the next level,” Coyle said. “You just about have to be an insurance expert to know the different steps and everything.”
That external appeal goes through the office of the state insurance commissioner John King.
“We understand the policies because we approve them. People need to know they have a resource in this office that is on the side of the consumer,” King said.
Last spring in a consent agreement, King’s office fined Blue Cross Blue Shield the largest judgment in state history — $5 million — for a long list of problems including processing errors and failure to reply to consumer complaints in a timely manner.
The insurer told Channel 2 Action News that those problems are unrelated to Douglas’ repeated denials and that the matter was reviewed in accordance with Anthem’s clinical guidelines, which rely on scientific evidence and said that it was also reviewed by independent physicians.
A spokesman wrote, “To be clear, Anthem was not saying Mr. Douglas could not have treatment, we wanted to ensure he would receive the most effective care available.”
“I think that they are practicing medicine without a license. I really do. And I feel like someone should step up and make a stand and that’s what I’m trying to do,” Douglas said.
Copyright © 2023 WSB-TV