Seattle transplant patient calls for sweeping changes after surgery denied by an OB/GYN

SEATTLE, Wash. — A Greenlake man, in need of a heart transplant, is calling for sweeping changes after his surgery was denied by an OB/GYN at his insurance company.

Regence BlueShield says it doesn’t have specialists making decisions because any MD, regardless of specialty, can interpret clinical information.

But Greg Pfeiffer says if they can make a mistake with him, he fears it could happen to anyone else.

The 44-year-old was born with several heart defects and has been living with a pacemaker since he was 3.

His condition is a complicated one, so that's why it's even more baffling that the doctor who denied his heart transplant this March, was not a cardiologist.

“One of the things I learned along the way was that the person who denied me was a doctor of gynecology,” Pfeiffer said.

It was a shock since he'd been on the transplant list at UW for the past year, and was previously approved by Regence Blue Shield.

“It was the one thing  that was keeping me going was the opportunity to get a second chance at life,” Pfeiffer explained.

He even took a physical test he knew endangered his life to prove to insurance  he really needed a transplant.

But after he complained, he received another about face from insurance. His transplant would now be covered. Dr. Csaba Mera, the deputy chief medical officer at Regence Blue Shield, called to tell him it made a mistake.

In an email, Mera wrote that the OB/GYN “... should have reached out to me... We could have avoided issuing a denial then if that discussion would have taken place."

But it's not good enough for Pfeiffer. He wants Regence BlueShield to overhaul its policy so that doctors are making decisions in their field of expertise.

“When you create a system that allows doctors to weigh in on healthcare they weren’t trained to do, it's wrong,” Pfeiffer said,

Mera said Regence BlueShield is making changes. In situations where a transplant was previously approved but may have to be denied, that doctor is now required to reach out to other colleagues to review the case together.

KIRO