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Dying Mother Denied Treatment by Health Insurance Company Despite Doctors’ Pleas Gets a Fighting Chance

Erika Zak is a 38-year-old mother who has been battling cancer for the last four years and now she is dying. It’s not the cancer that is currently threatening her life. A radical treatment cured her cancer, but a surgery gone wrong has her on the verge of death. Now, her insurance company is refusing to pay for a liver transplant, the one treatment that could save her.

Shortly after giving birth to her now four-year-old daughter, Zak was diagnosed with stage-four metastatic colon cancer, which subsequently spread to her liver. Her outlook appeared dim until doctors rolled the dice with a cutting-edge immunotherapy cancer drug called Pembrolizumab. Sold under the brand Keyruda, this drug was one of Zak’s last, best hopes, and it worked. Her doctors have called her response to the drug “incredible.”

As of right now, there’s no evidence of cancer in Zak’s body. Her outlook should be good, but a microwave ablation surgery gone wrong has left a huge hole in her liver. Her bile must now be pumped from her body into external bags and her poorly-functioning liver is causing a host of other problems for her.

For Zak, infection and death is always right around the corner. Doctors don’t know how long she’ll last, but her prognosis is dim. She has one chance, however. A liver transplant would grant her a new lease on life. Over a hundred doctors have examined her case, and the general consensus is that Zak needs a liver transplant.

In February, her doctors placed her on the liver transplant list. For the first time in years, Zak had hope that she might be able to lead a full and healthy life with her young daughter and husband. Then the shocking news came: Her insurance company denied the operation.

Why? Officially, it’s because a liver transplant would count as “unproven health services,” something that her plan doesn’t cover. Unofficially, it’s probably the $200,000 price tag that has her insurer balking.

Zak has been fighting with her insurance company over the past several weeks, but each time she has run into red tape. Her case is extremely complex, but each rejection and many steps of the review process have been marred by incompetence. Doctors and reviewers have repeatedly misread her medical documents, misdiagnosed her situation, and otherwise failed to understand what is going on.

Her insurer has argued that her liver failed due to chemo and as such a transplant would likely fail. However, this is false. Her liver was destroyed by a surgery gone wrong. One doctor examining her medical records confused the huge hole in her liver with a tumor. Another doctor said she has life-threatening lesions. In both cases, this simply isn’t true.

Zak wrote to the CEO of UnitedHealthcare directly, hoping for an appeal. Again her case was denied. The denials come even as her own doctors have made it clear that her prognosis following a liver transplant would be good. They do not believe that cancer is still present in her body. They do believe she’d have a similar outlook as anyone who undergoes a liver transplant.

Her doctors have been pleading with UnitedHealthcare, but the insurance company has largely failed to engage them. During the review process, her case was sent to three doctors. Just one of these doctors reached out to Zak’s medical team, then subsequently gave her a positive review. The other two doctors failed to reach out and rejected her appeal.

Zak’s case is a harsh reminder that when medical care revolves around money, the dollar triumphs over all. She has already been delayed for months and as each day passed, her odds grew longer.

But Zak and her husband never relented. They kept making calls and sending emails, pleading and hoping for that one big break. Finally, it arrived.

According to a CNN expose, it became known that Zak’s story was being composed for major media release.  UnitedHealthcare reversed course and approved Zak’s transplant surgery after all. A weakening and dying mother’s endurance and determination turned into a wish come true.