Insurer okayed out-of-network care for heart patient but family faces huge bill – washingtonpost.com

By Jordan Rau

Kaiser Health News
Tuesday, January 19, 2010

RICHMOND — Five months into pregnancy, Jodi Lemacks discovered that her unborn son had a severe heart defect and would require a complex operation as soon as he was born. But the local pediatric heart surgeons didn’t inspire confidence.

One surgeon “had just lost a baby with the same defects,” Lemacks says, “and he only did six of these surgeries a year, which is not a really good number.”

So Lemacks and her husband, Mark, selected a Philadelphia surgeon who was one of the most experienced in the nation at performing the challenging operation. It involved draining the heart of blood while the surgeon reconstructed the aorta, which in a newborn is thin as a string. Even in the best of hands, Joshua had only a 5 percent chance of surviving to the second surgery he would need six months later, several specialists told the Lemackses.

Insurer okayed out-of-network care for heart patient but family faces huge bill – washingtonpost.com

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