KANSAS CITY, Mo. — Blue Cross and Blue Shield of Kansas City denied covering the cost of one metro woman’s medicine that could save her life, leaving her with an over $8,000 monthly bill.
“I was at risk for spontaneous internal bleeding that could kill me,” Kaitlyn Sy said.
Sy, a KU Medical student, said she’s fighting back just weeks after a near death experience.
The conduct of insurance companies and their claims processes has been front of mind, following the killing of UnitedHealthcare’s CEO in New York on Dec. 4th.
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Sy says she’s been forced to pause her medical studies while waiting for this medicine to be approved, compromising her already weak immune system.
For her interview Wednesday with FOX4, she had to conduct it over ZOOM, unable to do it in person, she said, because of her condition.
Since middle school, Sy has dreamed big. That dream, to one day, be a doctor in some capacity.
“Whether that be bringing hope and healing to fellow humans, intellectual stimulating work of diagnosing and treating diseases, being involved in medical research,” Sy said.
But three years ago, a curve ball was thrown her way. She was diagnosed with an autoimmune disease that mistakenly attacks cells called platelets.
When she bleeds, there’s nothing there to clot those cells, which could lead to her bleeding to death and for years no treatment has worked good enough for her.
Just weeks ago, this scenario played itself out, forced to go to the ER where she was bleeding internally. Her hematologist had one more option a pill called ‘Promacta’ that could help once and for all stabilize this issue until she got to the pharmacy.
“The pharmacy tech – her eyebrows go up – and I said this can’t be good and she says this medication is going to cost you over $8,000,” Sy said.
Sy said she can’t afford to pay the bill every month simply to live. She called her insurance company, and they stood by the denial.
FOX4 asked her provider, Blue Cross and Blue Shield of Kansas City, about the denial. FOX4 was sent the following statement.
“At Blue Cross and Blue Shield of Kansas City (Blue KC), we are committed to the health and wellness of our members. Two of our primary responsibilities are to safeguard our members’ health information and protect their privacy. Because of this, we cannot talk about the specifics of this, or any other, case.
In general, Blue KC offers multiple insurance plans at various price points, allowing members to choose what works best for their circumstances and budgets. Differences in plans can include things such as smaller or larger provider networks (how many medical providers are in network for the plan), prescription drug coverage (some plans only include coverage for generic medications), and higher or lower copays and/or deductibles.
Before signing up for any health insurance plan, we encourage consumers to work with their human resource departments or an insurance broker to ensure the plan they are considering will meet their needs.
We are available to walk members through their plans so they fully understand their coverage, and have appeals processes in place to ensure concerns are addressed.“
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The provider told her that she had the wrong insurance, even though her insurance card lists the type of coverage that would cover the medicine she has to have.
“I would like to think as a medical student, I’m not a dumb person, but if my insurance card says preferred card blue, what plan do you think I’d be on,” Sy said.
As of today, she is still left without the meds she needs. She posted her story, and it went viral, she says she refuses to be silent not for her but for the people who have no one to fight for them.
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“There are thousands if not millions of other people who are suffering due to being denied and delayed this medically necessary treatment and I feel as they I owe it to these patients to use my voice to make their voices heard,” she said.
The insurance company says she needs to file an exemption letter in order to get this life saving medicine according to Sy.
In the meantime, people on the internet have started a GoFundMe and it has raised over $4,000.
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