Fifteen-year-old Cara Pressman was recently denied approval by her insurance company to cover a type of minor brain surgery that could end years of uncontrollable seizures. CNN reported that the procedure, called laser ablation surgery, is “minimally invasive” and could make all the difference for this teen.
In an interview with CNN, Pressman said that she had been getting seizures since she was in preschool. Her seizures can occur at any time and in any place. They can be triggered by stress, or even by feeling happy.
CNN reported that Pressman’s seizures can last anywhere from 20 seconds to two minutes and she’s cognizant of her surroundings the entire time.
Once, when she was 9 years old, she had multiple painful headaches. That night, the family dogs alerted Pressman’s parents that she was seizing by barking. They found her in her bedroom with blood running down her face from biting her tongue.
“It’s like having a nightmare but while you’re awake.”
There was a lot of built-up anticipation that Pressman would receive the procedure, finally putting an end to the seizures that have plagued her throughout her life. When Aetna informed the family that they would not cover the surgery just three days before she was scheduled for it, she felt her world crumble.
“When my parents told me, I went kind of blank and started crying. I cried for like an hour.”
Since she was denied the procedure, Pressman has endured more than 24 seizures. She had a message for Aetna regarding their refusal to cover her surgery:
“Considering they’re denying me getting surgery and stopping this thing that’s wrong with my brain, I would probably just say, ‘Screw you.’ ”
Aetna sent a letter to the Pressmans, explaining the rejection by calling the procedure “experimental,” CNN reported:
In denying Cara her surgery, Aetna said it considers laser ablation surgery “experimental and investigational for the treatment of epilepsy because the effectiveness of this approach has not been established.”
The company added that “[c]linical studies have not proven that this procedure is [SIC] effective for treatment of the member’s condition.”
Neurologists would disagree with Aetna’s view of the surgery, according to CNN. Many recommend it to their patients because they believe laser ablation surgery is better than the alternative, an open brain surgery called temporal lobotomy, in which a portion of the brain is removed. With laser ablation, doctors can pinpoint the exact location in the brain that needs to be treated.Screenshot/CNN
Neurologists consider laser ablation, which is performed through a small hole in the skull, to be safer and more precise than traditional brain surgery, where the top portion of the skull is removed in order for doctors to operate.
In an interview with CNN, Dr. Jamie Van Gompel, a neurosurgeon at the Mayo Clinic, explained that the difference in recovery time from the two surgeries is significant; a temporal lobotomy requires between six and 12 weeks of recovery time and laser surgery only requires two weeks or less time in recovery.
However, Van Gompel said that data proves that the surgery is effective 50 percent of the time, versus brain surgery, which has a success rate of more than 70 percent. He added, though, that one downside associated with temporal lobotomies is the high risk of complications, which includes death.
Pressman’s father, Robert, told CNN:
“It’s just so frustrating for us to know there’s a solution out there — a way to fix our daughter — and some bureaucratic machine is preventing this from happening. You get so angry, but you don’t know who to take it out on, because there’s no particular person that’s doing it. It’s this big bureaucracy that’s preventing this from happening.”
The Pressmans plan to appeal Aetna’s decision, although they aren’t confident that it will change anything. They still want the procedure for their daughter, even if it means dipping into their retirement savings to pay the $300,000. But her parents believe the procedure is worth the cost if it means improving Pressman’s quality of life.
You can watch CNN’s interview with Pressman below.