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Petitioning Blue Cross Blue Shield

Approve needed procedures which will stop Keratoconus from BLINDING my son

Blue Cross Blue Shield of NC has decided to deny my son “Terell” for two needed medical procedures that have been proven to stop “Keratoconus” from progressing eventually causing one to lose vision, but they’ll pay for a Cornea Transplant once his vision is practically gone. (So- let’s get this right, let’s wait until my son can barely see in front of himself and then and only then will we help) Blue cross has definitely lost my vote for being my son’s cross and as far as the shield he’d be blind by the time they decided to shield him. It’s very upsetting to know that you pay insurance companies to be there for you in situations like this, but when the unforeseen happens, they leave you to fight alone. It’s more than heartbreaking.

I’m a mother trying to help her son. One evening my son looked at me and said, “Mom I think I’m going blind.” On Monday July 9th the following week he was diagnosed with “Keratoconus”. Keratoconus is a rare eye disease: causes- unknown. (Also known as Pellucid) is a progressive non-inflammatory disorder that causes a characteristic thinning and cone-like steepening or bulge of the cornea. This steepening results in distortion of vision, increased sensitivity to glare and light and an associated reduction in visual acuity. Currently this disease affects 1-500 where is use to be 1-2000.

He started noticing that his vision getting worse at the age of 16, but his doctor stated that at 21 he would be a candidate for Lasik surgery and he didn’t see reason for concern. He never mentioned anything about an eye disease, basically because he didn’t know. We’ve been on a roller coaster ride since July 9th. Currently he doesn’t have a driver’s license because cannot drive due to the loss of functional vision is his right eye. (He’s experiencing halos, double, ghostly shadows, and blurred vision. He’s at the age when one is looking for his independence, working and trying to focus on a career, but BCBS of NC has placed a denial stamp on that. We’ve been with BCBS for years, paying over $500 a month for family benefits and now that we need them they toss us to the wind for us to find funding for needed procedures on our own. It’s hurtful and sad. The reason for denial is: the request does not meet the definition of Medical Necessity found in the members benefit booklet (investigational, experimental) Wow- two medical procedures clearly submitted by two doctors to stop one from going blind isn’t in the book… what about what’s needed? What’s necessary? What’s proven to help?

I was told by the doctor that diagnosed my son with Keratoconus that there was a procedure called Collagen Cross-linking, but that it had not reached our area yet. Terell is in intolerable to RGP (Rigid Permeable Gas) hard contacts and glasses weren’t working. Since then I went on a mother’s expedition to find medical help that would not only improve his vision but stop this disease in its tracks. I found the procedure when I stumbled across Doctor Brian Wachler-Boxer. My son’s medical eye charts were forwarded to Dr. Brian’s office in California. After review, he recommended Holcomb C3R Cross-linking in both eyes and Intacs only in right eye were the disease has progressed. During continuous research, I finally located a doctor in the area who also recommended Collagen Cross linking and Intacs as well. Holcomb C3R Cross-linking: a noninvasive treatment with Riboflavin applied to the cornea then activated by a special light, which helps prevent further progression of the disease and has been proven to stabilize deterioration. The cost of this procedure is $3350 per eye compared to $21,000 for a cornea transplant. Further, there is no risk of rejection, whereas a cornea transplant has a 30% rejection rate. Intacs: corneal implants are clear, thin corneal implants placed in the periphery of the cornea by an ophthalmologist during a brief outpatient procedure. Intacs corneal implants reshape the curvature of the cornea from within, enhancing the natural shape of your eye to correct mild nearsightedness. Because no tissue is removed, natural optics is enhanced and the structural integrity of the cornea is maintained. The cost of Intacs is $4300 per eye, compared to a cornea transplant of $21,000

Please sign my petition and join me demanding that BCBS of North Carolina make this right. We ask that they approve these procedures, and not wait until my son has no vision. I ask that BCBS of North Carolina stop denying proven treatments that remove pain, save lives, and save vision. It is time that they are held accountable for their decision making. We are not numbers we are HUMAN. Thank you for your support and prayers.

Caring Mother, Delores

• FDA-approved as safe and effective
• FAA-approved for pilots
• Excellent results - in U.S. clinical studies, 97% of patients saw 20/40 or better with Intacs cornea implants, 74% saw 20/20 or better, and greater than 50% saw 20/16 or better.
While crosslinking is used in virtually every country around the world, it is still in the FDA approval process in the United States.
Corneal collagen crosslinking (CXL) was developed in 1998 by Theo Seiler, MD, and has been shown in numerous clinical trials to strengthen the eye's clear surface (cornea) through the application of riboflavin, a form of vitamin-B2, followed by treatment with ultraviolet A (UV-A) light.

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