Insurance denied appeal for surgery

Hi all, 30/F/Blue Cross Blue Shield/~150k combined income/yr. I've been working closely with a surgical oncologist for a hepatic (liver) adenoma secondary to being on birth control the past 2-3 years. It originally ruptured in 2020 but I was stabilized and have gotten serial MRIs since it's shrinking after stopping the birth control. The shrinking has slowed down (it's about 3 cm now on the central part of the liver) so it's finally time to get the ablation (burning of the mass) and insurance denied it. We did a formal appeal, my specialist wrote a long letter citing multiple papers, and insurance denied it again. They're calling it "experimental" and they will only approve liver resection (cutting off half my liver). My doctor does not feel my case warrants a liver resection since it's a.) an adenoma, not a true cancer like carcinoma and b.) it's shrinking, albeit very slowly. It'll likely never completely shrink and there's a small risk of it turning malignant, so he wanted to do the ablation with a laparoscopic approach just to be extra cautious. A liver resection would be full open abdominal surgery with more risks.

He said my insurance will likely never approve ablation because my condition is so rare there are standards of care that have been established and will likely never be revisited in my lifetime. But he also told me to try a different insurance company at the same time? I was looking at switching to Aetna (my significant other's insurance) but it has the same thing about ablation being experimental for adenomas. I find hopping around to different companies every year in hopes that one will approve my surgery ridiculous and unnecessarily expensive.

I'm just so defeated. I don't know what to do. I hate that insurance companies can dictate how a board certified specialist practices medicine. Am I just out of luck and have to live with this thing or get the riskier resection surgery my specialist feels is unnecessary? Tyia.

submitted by /u/Tigrae
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