Insurance Covers $150k Surgery After I-Team Intervention for Florida Woman

Patient's Medical Crisis and Initial Denial

• 💡 Maline Rogers faced a severe diverticulitis attack in 2022, leading to a perforation in her colon and excruciating pain.
• ⚠️ Doctors warned that delaying surgery could result in permanent colostomy or death from sepsis if an abscess ruptured.
• 📌 Before her December surgery, Rogers was told to pay $26,000 upfront, as her insurance company had not yet approved the procedure.
• 💬 She was assured by the insurance company on a recorded line that approval was not necessary if the doctor deemed the surgery medically necessary.

Unexpected $150,000 Bill and Appeals

• 📉 Following the surgery, Rogers received an Explanation of Benefits stating she owed $150,000, with the insurance company denying any payment.
• ⚖️ Rogers and her doctors pursued two appeals and a peer-to-peer review, with doctors advocating for the necessity of the procedure.
• 🏥 Advent Health, the hospital, stated their commitment to supporting patients through the appeals process and providing necessary documentation.

I-Team Intervention and Resolution

• 🎯 The ABC Action News I-Team got involved after Rogers reached out, highlighting her case as part of the "Patient No More" series.
• ⚡ A day after the I-Team contacted her insurance provider, Oscar Health, Rogers received confirmation that her claims were approved.
• ✅ Oscar Health's vice president of communications confirmed the procedure was covered and that their clinicians were working with her doctor.
• 📣 Rogers expressed shock and relief at the swift resolution, urging other patients to keep fighting for their medical claims.

Broader Systemic Issues

• 📢 The "Patient No More" series aims to shed light on the struggles of patients fighting denied medical claims for doctor-approved treatments.
• 💻 Viewers can find more information and submit their own cases through a QR code and form on abcactionnews.com/patientnomore.