Nov 16, 2007 10:31 pm US/Pacific
Call Kurtis: Carrie Emard
SACRAMENTO (CBS13) ―
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Call Kurtis, CBS 13, KOVR, Kurtis Ming
Carrie Emard isn't 30-years old yet, but she's already survived a fight for her life. And she just won the fight of her life!
"I was screaming at the top of my lungs. And I started crying and screaming and crying, and it was the best news I've ever gotten in my life!" says Carrie.
This is Carrie last may. She was diagnosed with a crippling case of endometriosis, the worst her doctors had ever seen.
She elected for unusual surgery by a specialist in Oregon to remove it all.
Endometriosis is a condition where cells from the lining of a woman's uterus for some reason spread throughout her body.
In Carrie's case, the disease was actually strangling major organs.
"It was everywhere. In my chest cavity, my diaphragm, my bowels and my bladder, " explains Carrie.
Carrie's insurer, Healthnet, agreed her condition was serious. But they kept referring her to surgeons in network, who she says told her they couldn't remove all of the disease.
So after requesting a referral, Carrie got that out-of-network surgery to remove all her endometriosis.
Carrie lost two-feet of intestine, and needed other organs rebuilt.
"There were two-other surgeries those three-and-a-half weeks that I had to have done because of complications," Carrie told us.
Those surgeries were literally to save Carrie's life.
So, Carrie Emard says it came as a shock when Healthnet refused to help. She started fighting back, and she called me.
We pressed Healthnet on why they wouldn't pay.
The company says it never approved Carrie's request for a referral to that Oregon specialist, and points out they rejected her claim before she had the surgery.
She was appealing that rejection when she went under the knife.
But Healthnet claimed the Oregon endometriosis procedure was not a medical necessity. Carrie appealed to the state.
"I would never give up, until justice was served. I mean, it's not right!" Carrie said.
In late September, the department of managed health care ruled in favor of Healthnet.
So Carrie appealed again. The state sent her case to an independent medical examiner, a specialist who evaluates these situations.
This month he ruled Carrie's surgeries are medical necessity, and the state ordered Healthnet to pay the $250,000.
"Oh yeah. Probably the biggest burden is off my back now, " Carrie says relieved.
So after more than 10-years of declining health, Carrie Emard is finally dancing, and making plans.
"Yeah! That's so true! I can go to school, I can travel, I can go outside and exercise," Carrie says happily.
"You just can't give up. That's all I can say," she concludes.
So far, Healthnet has not responded to our request for comment. They have no appeal on this ruling, and have agreed to pay.
If you have an issue you can't resolve with your managed health insurer, you can do what Carrie did, and contact the Department of Managed Care's HMO help center.
We can link you through CBS13.com, in the call kurtis links. And take Carrie's advice: Don't give up!
(© MMIX, CBS Broadcasting Inc. All Rights Reserved.)
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