A denied medical insurance claim can leave you without the critical care you need. For Danielle Barcilon, it led to months of fighting to get reimbursed for thousands she spent on surgery and therapy.
A denied medical insurance claim can leave you without the critical care you need. For Danielle Barcilon, it led to months of fighting to get reimbursed for thousands she spent on surgery and therapy.
Barcilon was hit by a car while biking in 2021.
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WATCH HERE“The impact of the accident ripped the cartilage in my hip that holds my leg to my torso,” Barcilon told NBC6.
After she was treated for her injuries, Barcilon says she found herself still in pain that wouldn’t go away.
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“I would limp when I was walking, or the instability would cause pain in my lower back or the front of my body,” Barcilon said. “And I brought it to the attention of my doctors, who were treating me then. It went undiagnosed. That was until last summer when the pain became so severe that I couldn't function.”
Last August, Barcilon says she was diagnosed with a right hip labral tear and says her doctor told her she needed to undergo a surgery he said was medically necessary.
“This, to me, is not a frivolous surgery. It securely attaches my leg to my body,” Barcilon said.
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Barcilon’s insurance denied her claim even after she says her doctor had a peer-to-peer review with Aetna. In December, she decided to proceed with the surgery and paid roughly $20,000 out of pocket for the procedure and physical therapy.
A decision she doesn’t regret.
“He found out I was bleeding internally. So, it was necessary,” Barcilon said.
After the surgery, Barcilon filed an appeal asking her insurance company to reconsider their decision. That appeal was denied. At the time, Aetna told her she should have had an injection to the hip before surgery; something Barcilon says she was not told prior to surgery.
She filed a second appeal and called NBC6 Responds for help.
We reached out to Aetna about her denied claim. Within days, she got a phone call from the company with an offer of reimbursement of most of the surgery’s cost.
In a statement, Aetna told NBC6 Responds, “Aetna is committed to helping our members receive high quality appropriate care at the right time. Our customer service and clinical team reviewed the additional information sent on behalf of Ms. Barcilon, and we were able to complete a favorable adjustment to the claims on her behalf. We will continue to work directly with Ms. Barcilon to address any further concerns.”
Ending a Saga, Barcilon says she shouldn’t have had to go through.
“I mean, to have to make these decisions at a time when I'm in pain, it's not easy,” she said.
Most Americans don’t go to the lengths Danielle went to get her denied health insurance claim approved.
In fact, an analysis of ACA marketplace plans by the Kaiser Family Foundation found less than 1% of denied health insurance claims were appealed in 2023.
