Woman sues Regence over denied surgery claim
MERCER ISLAND, Wash. -- Dina Wampold pays good money for health care coverage through Regence.
So when the Regence Group refused to pay for a doctor-recommended neck surgery, she filed a lawsuit.
A few months ago, Wampold was suffering from a herniated disc that was only getting worse.
"It felt like someone had punched me in the arm," she said, " pretty severe arm pain."
After reviewing all her options, a surgeon recommended disc replacement. But Regence wasn't on board.
"I expected when I was in need that they would step up, and it's really disappointing that they don't," said Wampold.
Regence spokesperson Rachelle Cunningham issued a statement, which said, "Wampold requested coverage for a service that was denied as an investigational procedure."
But according to Wampold, Regence is the only one that's skeptical about the procedure.
"The surgery is FDA-approved, you know. Medicare pays for it. The state pays for it. The military pays for it, and other insurance agencies will pay for it," she said.
She says it's especially frustrating since Regence was willing to pay for a more expensive procedure to fuse Wampold's spine, but not for the cheaper disc replacement that would have helped her the most.
"So the insurance company, for bureaucratic reasons, is trying to force her to get a worse surgery, and that's just not right," said husband Mike Wampold.
Out of options, the Wampolds decided to borrow against their house to pay the $60,000 surgery fee out of their own pocket.
Regence has 20 days to respond to the lawsuit which the Wampolds say is their way of telling the insurance company to leave the treatment decisions to the doctors.
So when the Regence Group refused to pay for a doctor-recommended neck surgery, she filed a lawsuit.
A few months ago, Wampold was suffering from a herniated disc that was only getting worse.
"It felt like someone had punched me in the arm," she said, " pretty severe arm pain."
After reviewing all her options, a surgeon recommended disc replacement. But Regence wasn't on board.
"I expected when I was in need that they would step up, and it's really disappointing that they don't," said Wampold.
Regence spokesperson Rachelle Cunningham issued a statement, which said, "Wampold requested coverage for a service that was denied as an investigational procedure."
But according to Wampold, Regence is the only one that's skeptical about the procedure.
"The surgery is FDA-approved, you know. Medicare pays for it. The state pays for it. The military pays for it, and other insurance agencies will pay for it," she said.
She says it's especially frustrating since Regence was willing to pay for a more expensive procedure to fuse Wampold's spine, but not for the cheaper disc replacement that would have helped her the most.
"So the insurance company, for bureaucratic reasons, is trying to force her to get a worse surgery, and that's just not right," said husband Mike Wampold.
Out of options, the Wampolds decided to borrow against their house to pay the $60,000 surgery fee out of their own pocket.
Regence has 20 days to respond to the lawsuit which the Wampolds say is their way of telling the insurance company to leave the treatment decisions to the doctors.