Health: NJ Mom Surgery Denial Follow-Up
CBS Philly (con't)
Affordable Care Act Updates: CBSPhilly.com/ACA
Health News & Information: CBSPhilly.com/Health
Get Breaking News First
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