Woman denied surgery by insurance finds hope after months of fighting

SHELBY, N.C. — Anna McDaniel and her husband had big plans for their RV last summer. They planned to go across the country.

But her back had other ideas. “Pain down my legs, just harder and harder to walk,” she told Action 9’s Jason Stoogenke.

McDaniel said more and more, she was confined to her bed or sofa. Her doctor suggested surgery, a two-day operation.

“My surgery was supposed to be on the 29 and 30 of July,” she said. But her insurance wouldn’t cover it.

“They’re saying it’s not medically necessary,” she said. “I go one day in tears. The next day, I’m mad. I need this done so badly, and I don’t understand how it cannot be medically necessary.”

McDaniel further explained that her out-of-pocket cost would have been around $600,000. As you might imagine, that was not an option.

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“I feel like my hands are tied,” she said. “I don’t know what to do. I don’t have any idea what to do.”

McDaniel complained to the N.C. Department of Insurance, but said nothing changed. She said no lawyer would take the case and that her doctor kept pushing for another review.

Finally, she emailed Stoogenke. “That was my last chance. Whatever they said was what it was going to be,” she told him.

For about a month, Stoogenke went back and forth with Aetna. They ultimately wrote, “Aetna is committed to ensuring our members have access to high-quality, appropriate, and affordable care. All members have the right to appeal coverage decisions. In this case, Ms. McDaniel’s claim is currently undergoing clinical review as part of the appeals process. Once the review is complete, we will communicate a decision directly to Ms. McDaniel.” It was a positive sign.

Five weeks later, McDaniel emailed Stoogenke the good news: her surgery was approved. “Honestly, I was a little bit in disbelief, like I will believe it when I see it,” she said.

And she did see it. After months of waiting, McDaniel had the procedure on October 21 at CaroMont Regional Medical Center in Gastonia.

Stoogenke visited her around the holidays to check on her. “I’m doing great. “I’m doing great,” she said. “I’m able to walk upstairs. I’m able to do pretty much what I need to do.”

She said that until the surgery was approved, she would be in a wheelchair. She called the procedure a “life-changer.”

And, just a couple of weeks ago, a WSOC producer went back for one more update. “I’m doing great. Every day a little better,” McDaniel said.

She was making even bigger strides, literally. “Please, if you need help, call Jason. He is amazing, and I could never thank him enough,” she told the producer. “He cared about my situation. He’s very genuine. I knew he wanted to help me. It wasn’t just one of those. I’ll see what I can do. No, he fought for me. And I needed someone in my corner.”

By helping McDaniel, Stoogenke has now saved consumers more than $1 million since he started keeping track in 2019.

As for that RV trip she and her husband had been planning, she’s waiting until after winter. But this time, because of the weather not her health.

Here’s his advice for any patient if insurance won’t approve a procedure: while McDaniel said this didn’t work for her, still reach out to your state’s department of insurance, and you may also consider a lawyer.

No matter what, make sure you appeal, be persistent, and you can always reach out to Action 9.

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