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Health: NJ Mom Surgery Denial Follow-Up

PHILADELPHIA (CBS) — A follow up on a life saving surgery for a New Jersey mom that had initially been denied by her insurance company — 3 On Your Side stood up for her, and Medical Reporter Stephanie Stahl has the update.

These special mother-daughter moments have new importance now. Terminal liver cancer was threatening 45-year-old Kim Cirucci’s life.

“There was no hope,” said Kim.

Back when we first met Kim, her daughters and mom in July, they were in turmoil and desperate.

“I couldn’t live without her,” said Carmel Mozef, Kim’s mother.

“It’s just hard. I cry,” said Gianna Cirucci, Kim’s daughter.

Kim, who remarkably never looked sick, had been denied coverage by her insurance company for a revolutionary operation that could save her life.

“I couldn’t even begin to find the words that describe what I feel Steph. I couldn’t even begin. It broke my heart. It really did,” said Carmel.

Horizon Blue Cross Blue Shield of New Jersey said the surgery at Columbia in New York was denied because it was experimental.

Stahl asked, “But you and the doctor are saying this isn’t experimental?”

Kim replied, “And they interviewed the doctor the first time around and still said no, it’s experimental.”

She filed an appeal, and reached out to CBS 3 for help. We called Horizon, where the appeal process had been underway. Within a few hours of our call, the denial was reversed. Horizon says it was based on a conversation its Chief Medical Officer had with the surgeon.

Kim had the 13 hour surgery in late July. It was pioneered by Dr. Tomoaki Kato.

“Instead of just taking the tumor out, we take the organ and tumor together. They go out of the body,” said Dr. Kato. He says that allows him to more efficiently remove the tumor and reconstruct the liver.

Kim had a series of set backs, including infections, but the cancer is gone.

Stahl said, “For as difficult as it was, it saved your life.”

Kim said, “This saved my life, definitely saved my life.”

“I’m thrilled. I can’t tell you how much,” said Carmel.

Now Kim is trying to gain weight by eating things like her new favorite pumpkin pie. She hopes her story inspires other people to be determined and fight back when something is wrong.

“It just renews your faith that if you believe and you fight hard enough, it can be done. It definitely, anything is possible,” said Kim.

She still has to undergo chemotherapy because the cancer she had often comes back.

For now, Kim’s resuming her life, and plans on setting up a non-profit organization to help other sick people who are having problems navigating through insurance problems.

Reported By: Stephanie Stahl, CBS 3

More from Stephanie Stahl
  • Kim Mozeff-Cirucci

    Sorry to see that my story sparked so much negativity regarding insurance companies. I only wanted people to know that if a claim is ever denied, sometimes it’s worth the fight to have it overturned. Insurance companies have a job to do & so do patients. The true purpose of my story was to instill in everyone the importance of never giving up no matter what the situation is. We are all faced with obstacles in our lives, but persistence is the key. I never believed my tumor was inoperable, although I was told that by many physicians. I kept searching until I found that brilliant, brave surgeon, Dr. Kato & I refused to accept that the surgery was denied. Bottom line…don’t ever give up,

  • CW

    You are misinformed about Medicare denying procedures and Amanda is correct. Medicare does not even have a precertification policy, if a Dr orders it, the patient gets it and Medicare covers it at 80% period. So many are misinformed about the Medicare program, I’m insured under an employer sponsered health care policy and i would give anything to have Medicare in it’s place. They pay fairly and promptly, unlike any major health care insurer I’ve had in the last 25 yrs.

  • ChaosNmotion

    Frank is correct, they do deny and delay treatment much longer than private insurance companies do and their appeal process is complicated by a lot of governmental red tape. I would suggest educating yourself on the facts before making such ignorant comments. I work in healthcare and see this everyday, we overwhelmingly prefer to deal with the private insurance companies than Medicare/Medicaid.

    • cw

      Your name suits you, you don’t know what you’re talking about and i highly doubt you are in the heathcare industry. I know becasue when you speak of Medicare and Medicaid in the same breath you give your ignorance reagarding the subject away.

  • christine

    So happy for this woman and her family.

    Amanda – do you really believe that the government is going to do a better job running health care?

  • Amanda Bonner

    Frank — my comments are based on experience with the health insurance industry and BC/BS both in NJ and in FL. As for Medicare/Medicaid — have you used Medicare? Do you have an elderly family member who used it? If you haven’t and if you haven’t faced a major medical situation then you have no idea what a godsend Medicare is when faced with multiple thousands of dollars of medical expenses.
    My comments are fact-based whereas I suspect yours are based on the “research” from a rightwing “think tank” bent on destroying Medicare/Medicaid.
    The bottomline in my original post is that without the intervention of CBS3 and the possibility of a lot of negative publicity, BC/BS would not have reversed their decision and this woman would have died. The problem is that there are thousands of others being denied treatment every day nationwide because they don’t have a TV reporter bringing the weight of their organization to bear on the health insurers and forcing them to do the right thing for the insured patient.

  • Frank

    Great story with a good ending.

    As for you, Amanda, pathetic that you had to soil it with your inane comments. Do some research and discover that Medicare/Medicaid deny more procedures than ALL insurance companies.

    Guess that fact doesn’t gibe with your warped view, eh?

  • Elaine

    P.S. Kim:

    Say hello to that wonderful Mom of yours, She was always so kind and generous with her home and to me.

  • Elaine


    I could not believe I was seeing you on TV, Thank God things turned around for you. And, to see your beautiful daughters – I remember only one. I used to type for you way back when – medical transcription. You are and always have been a wonderful young woman. You helped me when I needed it. God bless you and keep up the good fight.

    • Kim Mozeff-Cirucci

      Oh my goodness….is it really you Elaine. I’ve been trying to track you down for years. How can I get in touch with you? I’d love to chat with you. What an amazing woman you were & I’m sure still are. Miss you lots!!

  • Amanda Bonner

    Just remember all of you GOP-lovers — we don’t need healthcare insurance reform because the insurance companies are our “friends”. Thank God CBS3 got involved so that this woman got the surgery she needed.otherwise due to the weasels at Horizon BC/BS she’d have died.

    • Diane

      Amanda, for your information the insurance companies were big supporters of the new healthcare reform bill. They maintain most of their refusal rights and they have no limit on premiums they can charge for taking on people with pre existing conditions. The healthcare bill would not have made it any easier for this woman.

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