When she was a toddler, she scratched her eyes so badly they had to be sewn shut. When her teeth came in, she gnawed on her tongue like a piece of beef jerky until it was so swollen that she couldn’t drink.
Whatever teeth she didn’t break biting toys were removed to save what was left of her mouth.
Her family assumed that by the time her adult teeth came in, she’d have learned not to bite herself. But her adult teeth never came in properly. Her jaw had broken.
She and her family adjusted as best they could. Gabby learned to speak without teeth, even though she hated the gummy quality it gave her voice. She subsisted on soft foods, like bananas and pasta and anything that can be minced into harmless pieces. Now she’s a high school senior, ready to get out of her parents’ Big Lake house, and still toothless.
The Mayo Clinic put together a plan to fix Gabby’s broken jaw using bone from her hip, and to implant new teeth. The only problem: Gabby’s insurance company, Aetna, is refusing to pay for it, claiming the procedure isn’t “medically necessary.”
“To me, it’s utter bullshit that it’s not covered,” says Gabby’s father, Stephen. It’s not like Gabby didn’t brush her teeth and they fell out. Her toothlessness is was the result of her inability to feel pain, and her family’s attempts to save her from hurting herself. Now she’s an incoming college freshman who can’t eat meat or fresh vegetables.
“How can this be defined as anything but medical?” he asks.
Gabby’s procedure isn’t the only one Aetna has refused to pay for. There was 15-year-old Cara Pressman, who was refused a minimally invasive brain surgery that could stave off the seizures she’d been having since she was 9. The company said laser ablation, which neurologists consider safer and more precise than traditional brain surgery, was “experimental and investigational for the treatment of epilepsy because the effectiveness of this approach has not been established.”
A temporal lobectomy, which is more invasive and more expensive, was approved -- even though Pressman’s medical team didn’t even seek approval for it.
Then there’s Gillen Washington, a 23-year-old college student with a rare immune disorder, who’s suing the company for breach of contract and bad faith. When he was 19, he says, Aetna refused to cover an infusion of intravenous immunoglobulin without him coming in to get bloodwork done beforehand. He ended up in the hospital with a collapsed lung.
But what was more upsetting was testimony given by former Aetna medical director Jay Ken Iinuma under oath: He never looked at patients’ records before deciding to approve or deny care. The company is now under investigation by California’s insurance commissioner.
"If the health insurer is making decisions to deny coverage without a physician actually ever reviewing medical records, that's of significant concern to me as insurance commissioner in California -- and potentially a violation of law," California Insurance Commissioner Dave Jones told CNN.
Meanwhile, friends, family and even strangers who have heard Gabby’s story are rallying around her. They’ve raised over $20,000 for her over $100,000 procedure on Gofundme.com. Stephen says can’t believe the outpouring of kindness.
But he doesn’t think they should have to rely on kindness to get his daughter a jaw when insurance is supposed to cover it.
“It’s wrong, and people know it’s wrong.”