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PIneton Heres is alive today only for the generosity of an organ donor and his family, who gave her heart 12 years ago.
25 -year -old, Danon, from Ohio, was born with a rare congenital heart disease, Abustein’s discrepancy, Which affects the tricuspid valve on the right side of the heart. The condition, which causes the blood to leak backwards – can cause the upper right chamber of the heart – heart failure.
When she was 11 years old, after years of health problems, Haras had no choice, besides undergoing a heart transplant in March 2012.
Surgery was successful; The recovery is long and often painful, but Heres credited his donor to give him a “second chance” in life.
Since surgery, the Heres has been on a combination of drugs to ensure that his body does not reject that heart.
This year Heres had to fight the health insurance company, when she stopped covering her life -saving medicine for her life, she lived with all her life in her life.
If he does not get his medicine, it can prove fatal.
In February, the company wrote to inform him that one of the drugs he had taken since 2013, Everrolimus, “is no longer medical,” according to the paperwork seen by the paper. Independent,
The doctors of the haraes prescribed drug evergus as it prevents the body from rejecting an organ transplant. It also helps protect against coronary artery disease, a large risk after transplant operation. Everrolimus, when taken with immunospressant cyclosporin, was working well for Heres since 2013.
“It just blown my mind,” Heres recalled after receiving the letter. “I am liking, so you want me to go into rejection and die? What are you saying? Because it is not medically necessary?”
The refusal was especially fierce in the intestine because the heart was gifted to Heres by a 24 -year -old man, who suddenly died.
She will never be able to repay her donor for her gift, but Heres sent her mother a blue teddy bear recently sprinkled with stars, recording her heartbeat sound.
“I have been 13 and a half years with my heart gift,” Heres told Independent. “I have done everything right. And now, I think Anthem is taking it away from me.”
“He believed that his heart would be nurtured and preserved,” said Heres of his donor’s family. “And now the anthem is gambling with it. If they let me go into rejection, they are not just risking my life – they are letting them go to ruin their gift.”
Since implantation in 2012, doctors have tried different drugs to prevent Hece’s body from rejecting the heart. Some of them made him incredibly unhealthy and it took years to find a combination that worked.
“For the last 12 years I have survived due to a significant combination of drugs,” said Heres. “It was not some random option – it was determined by Cincinnati Children Hospital Medical Center as I was admitted to the hospital with serious side effects after rejection and even on other drugs.”
Heres, who works for a belief-based non-profit, received the first denial letter from Anthem in February. In the following months, he did everything to get to the bottom of the decision, including going into the official appeal process, but the company would simply return with more rejection, he said.
Meanwhile, his medicine was running out.
“If I do not have an Everolimus, I can lose the heart that saved my life,” Heres said that he should take it twice a day. “The anthem knows this – and yet, they block me. I also begged to pay from the pocket, and one of his representatives hung on me.”
Taking matters in his hands, Heres started a social media campaign and asked friends to follow him.
“Make noise. Tell them that the world is watching,” she wrote. “Any heart transplant patient – and no donor family – should ever be treated in this way.”
His post was shared thousands of times, which included Anthem’s Facebook page, where the supporters of Heres had shared their story in comments on every social media post shared by the company.
It seems that there is some effect. In mid -September, Anthem approached the doctors of Heres and informed them that the drug was approved.
When contacted IndependentAnthem said that the initial refusal was “based on medical guidelines”, but the company apologized and confirmed that it had approved the hares drug.
An anthem spokesperson said, “Initial denial of coverage for Everrolimus, and appeal decisions, were based on medical guidelines that did not fully reflect the history of the treatment of Ms. Heres,” said Anthem’s spokesperson. “We have approved the drug since then, and we really regret that because of it. We are reviewing the matter to strengthen our procedures and ensure future reviews to ensure that our members are better considering the personal needs.”
But now Heres faced his next battle against the company, which increased it to $ 350 for 30-day supply, or 90-day supply to $ 1,000. Prior to the hike, the hares supported by his parents will pay approximately $ 180 for 90-day supply.
The new anger is simply ineffective.
“Instead of covering the drug after my deduction instead of anthem, I will now have to pay $ 350 every month,” said Heres.
At the moment, the only method of hares can bear his medicine which is fully and using his insurance. Goodrx Coupons, which bring cost to $ 88.66 for a 30 -day supply – but it is far from reliable.
“The scary part is that these coupons are not guaranteed. They can change [the price] Or disappear at any time, “Heres said.” If this happens, I can never tolerate those prices, and it hurts me. ,
Heres says that he has no choice but to find a new insurer, but like many Americans, the health insurance industry in the US deeply concerns him.
Heres said, “I have cried a lot last month, I feel broken.” “Meanwhile, Anthem is a multibillion-dollar company that is making me a record profit, while leaving me to panic whether I will survive for a month.”
“It is disappointing that Anthem believes that it knows better than my heart transplant doctors, who have been managing my care for more than a decade.”