Insurance company covers man's heart transplant after surgery was previously denied

Thanks to his insurance company's change of heart, Greg Pfeiffer now has a fighting chance to survive the defective heart he’s been struggling with since he was born.

Pfeiffer has been living with a pacemaker since he was 3, and he's had dozens of open heart surgeries--but when. When his insurance company, Regence Blue Shield, said it wouldn't pay for a transplant, Pfeiffer researched found a flaw in their system.

The doctor who reviewed and denied Pfeiffer’s claim was not a cardiologist. She was, in fact, an OB/GYN.

“The general rule is if you can read clinical notes, and they consider every doctor capable of doing that, you can make these life-altering decisions," he said.

Pfeiffer appealed, the decision and shared his story on KIRO 7 and Facebook last year. On Facebook, he wrote:

“I have maintained health insurance on my own since I was 20. I make it a priority to pay the premium each month on time or early. In years gone by I have went without so that I could pay the premium and secure, not just health insurance but, the best plan Regence BlueShield offers. I did so knowing, since the age of 13, that I would one day need a heart transplant.”

Regence not only reviewed the case with a cardiologist, they agreed to pay for the transplant, and life-saving medicine he requires by IV, as he lives full-time in the UW Medical Center, awaiting a transplant.

Regence’s top doctor also gave Greg his cell phone number.

“Yeah they've been very responsive, he specifically has been very responsive," Pfeiffer said.

“They definitely have made an effort to treat me and what I need, as opposed to what someone who can read between the lines might be able to bar me from having."

Pfeiffer is now working to get all insurance claims be reviewed by specialists. In the meantime, he waits for lifesaving news.

“It could happen right now.” He said. “I could literally be getting a phone call at this moment, so every time someone knocks on my hospital  door, I wonder if they're there to tell me I'm getting a heart."

Cox Media Group