Help Fund Megan’s Tricuspid Valve
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I am asking for your help to support my mom’s new tricuspid valve. Two years ago my mom underwent her 3rd open heart surgery at the Mayo Clinic in Minnesota to replace her failing tricuspid valve. Unfortunately at some point over the last two years a blood clot formed on one of the leaflets of that new valve and it was permanently damaged. My mom went back to the Mayo Clinic in July 2023 to get the valve repaired or replaced. Dr. Eleid, her cardiologist at Mayo, confirmed that she has “severe prosthetic tricuspid regurgitation and associated class 3 heart failure symptoms.” Dr. Eleid recommended that my mom have a valve in valve procedure. She was scheduled to have this procedure on July 20, 2023 however, the night prior to the procedure she was notified that her insurance company would not cover the procedure. My mom came home in July with no resolution and started the appeal process with Regence Uniform Medical. On August 24, 2023 my mom filed her first appeal, included with the appeal was a letter from Dr. Eleid which stated “she is high risk for repeat cardiac surgery and thus we have recommended tricuspid valve in valve implantation with a balloon expandable Sapien 3 valve system. This procedure is well established and has an excellent safety record and will be much less invasive than a repeat cardiac surgery. If she does not have an intervention to correct the severe regurgitation of her tricuspid bioprosthesis she will be at risk of recurrent heart failure hospitalizations and associated morbidity.” On September 6, 2023 Regence Uniform Medical denied my mom’s appeal stating the procedure was “considered investigational as the current scientific evidence is not sufficient to establish the impact of these technologies on health outcomes.” On September 21, 2023 my mom went for a second opinion with Dr. Harper at Virginia Mason Cardiology in Seattle. Dr. Harper wrote a letter stating “I agree completely with the Mayo Clinic Cardiology assessment that a Valve-in-Valve transcatheter tricuspid valve operation, while “off label”, is really the only option other than heart transplant for Ms. Jensen. If she can’t have this done, she is at very high morbidity and mortality and recurrent hospitalizations for heart failure while undergoing the heart transplant evaluation.” Dr. Eleid wrote an additional letter stating “she has been evaluated by our cardiac surgeons at Mayo Clinic and given that she has had 3 prior sternotomies they have recommended that she undergo tricuspid valve in valve to reduce the number of cardiac surgery she will need in her lifetime. She is a good anatomic candidate for tricuspid valve in valve. We ask that you reconsider your coverage decision as we believe that this treatment is in the best interest of the patient.” On September 26, 2023 my mom filed her 2nd Level Appeal including the new letters. On October 3, 2023 Regence denied my mom’s claim stating “We appreciated your personal letter and the additional supporting letter and clinical documentation from your providers which we reviewed with your appeal. While we empathize with your situation, the reviewer found that the original denial was correct. As a result your appeal is denied.” In order for my mom to get this needed procedure on November 6, 2023 she will have to self-pay. The estimate given to her by the Mayo Clinic to self-pay for the valve in valve procedure is $177,000 (if all goes well). Mayo Clinic Patient Account Services told her that the Mayo Clinic requires monthly payments of 10% of your balance, which means my mom’s first monthly payment would be $17,700. When she inquired about Mayo Clinic’s financial assistance program she was told because she works and the combined income she has with Harley, they would not qualify. She inquired about Mayo Clinic’s Catastrophic Care program and the representative indicated again that she would not qualify. My mom said she is feeling very defeated but she remains positive that God has a plan. We are asking for your help to fund this needed procedure for my mom so she can get a new tricuspid valve which will improve her health as she starts the 2-3 year process of getting on the transplant list for a new heart.
Organizer and beneficiary
Miranda Cypher
Organizer
Yakima, WA
Megan Jensen
Beneficiary