UnitedHealthcare denied a dying mother's liver transplant, until she penned a letter to the CEO

An Oregon woman was diagnosed with stage 4 metastatic colon cancer that spread to her liver, after giving birth to her daughter four years ago. A poor outcome from a procedure to remove the cancer left her in need of a new liver, but her insurer denied it, CNN reports.

Here are six highlights from the approval process.

1. Surgeons removed cancer from the colon of Erika Zak, 38, four years ago. But a microwave ablation surgery aimed at removing two tumors from her liver last year went wrong, leaving Ms. Zak with a fist-size hole in her liver and irreparable bile ducts.

2. In the year after the poor outcome, Ms. Zak was hospitalized 19 times in Oregon for health problems including infections and bleeding, according to the report. More than 100 physicians at institutions that included the Cleveland Clinic determined Ms. Zak would die if she didn't undergo a liver transplant. 

3. Cleveland Clinic physicians put Ms. Zak on a liver transplant list on Feb. 2. However, her insurance company, UnitedHealthcare, denied the transplant. The insurance arm of UnitedHealth Group said the treatment, which costs about $200,000, wouldn't be "promising," CNN reports. After Ms. Zak appealed the decision, the insurer again denied the transplant.

4. On April 11, Ms. Zak penned a four-page letter to David Wichmann, CEO of UnitedHealthcare's parent company, UnitedHealth Group, pleading that he reverse the denials. She described errors in the review process, such as notes stating her liver failure came from "chemotherapy toxicity," and a medical director inaccurately stating that Ms. Zak had "life-threatening lesions," despite her physicians' insistence that her liver damage was caused by the poor outcome of the ablation surgery.

5. Despite the letter, Ms. Zak received another denial May 2. But on May 7, Ms. Zak suddenly got a call from UnitedHealthcare saying the procedure would be covered. UnitedHealthcare told CNN, "We had ongoing conversations with her husband and contacted him as soon as the decision was made to approve the transplant request." 

6. Ms. Zak is now on the liver transplant list. She and her family are moving to Cleveland for her surgery and recovery at the Cleveland Clinic. Federico Aucejo, MD, director of the Cleveland Clinic's Liver Cancer Program, told CNN he can see why the procedure wasn't as easily approved as other treatments. Ms. Zak's case is rare.

"It's a new territory," he told CNN. "I can't blame anybody."

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