According to Erika Giduturi, Blue Cross Blue Shield wouldn't pay for a liver transplant because the hospital through which she was slated to receive the organ transplant is not on its list of "blue distinction" hospitals.
A woman in need of a life-saving liver transplant amid her battle with a rare form of cancer has been forced to fight her insurance company and her husband's employer through which she receives her medical coverage because they will not approve of the hospital offering the surgery, she told Inside Edition Digital.
Erika Giduturi was diagnosed with a rare form of cancer called Cholangiocarcinoma, which affects the duct between the liver and the small intestines. Since August, the mother of three has been receiving medical treatment, including radiation and chemotherapy, at Emory University Hospital in Georgia.
"You know, I just, I want to see my kids grow up," Giduturi said. "I want to grow old with my husband, and these possibilities in front of me are scary."
In December, she got the green light to be added to the hospital's organ donor recipient list. But her insurance provider, Blue Cross Blue Shield, would not cover the cost of the organ transplant because Emory is not on its list of "blue distinction" hospitals that offer transplants, according to Giduturi.
Giduturi thought her insurance, a self-funded health plan that she receives through her husband's job at the Zachry Group, would make an exception for her since it had already paid thousands in medical bills for treatments. That did not turn out to be the case, she said.
"I was pretty devastated, honestly," Giduturi said. "Because this is, this is it for me. Like we've been told that transplant is my best option. It's really kind of my only option."
In a statement, the Zachry Group said, "As a result of Health Insurance Portability and Affordability Act (HIPAA) privacy requirements, we are not permitted to comment on the health of our employees, or dependents, covered in our Blue Cross and Blue Shield of Texas health plan.
"The health and wellbeing of our employees and their families are our top priorities," the Zachry Group continued. "When healthcare needs arise, we work diligently with our members to provide support and information regarding coverage. Blue Cross and Blue Shield of Texas determines policies related to where covered procedures and services are provided."
Now, Giduturi must drive almost six hours south from Forsyth, Georgia, to Jacksonville, Florida, to the Mayo Clinic, where she hopes to eventually get on their transplant list. But for that to happen, she needs more medical treatment and tests to be run.
"It is so frustrating," Giduturi said. "I cannot even begin. I could have been listed for transplant as early as Dec. 23, per Emory."
Friends and family have offered to pay cash for the transplant, which could cost upwards of $600,000, but she says Emory University Hospital told her they don't take cash payments.
Emory University Hospital would not comment on its stance on receiving cash payments. In a statement to Inside Edition Digital, the hospital said, "Emory Healthcare's top priority is to provide safe, quality care and treatment to all of our patients, and we advocate for our patients to obtain the care they need. Because of federal privacy laws, we cannot comment on individual patients."
And Giduturi says they have exhausted all other insurance options.
"Unfortunately, at this point, no, there's not another option. We've been told that we could, you know, get a divorce, and I would qualify for more. But I'm happily married," Giduturi said.
Blue Cross Blue Shield of Texas said in a statement to Inside Edition Digital, "Out of respect for our members' privacy, we do not comment on individual member situations. We are committed to providing our members access to safe, appropriate and effective health care that is backed by our dedication to evidence-based medicine and the highest value treatment options.
"Coverage decisions are based on sound clinical research," the statement continued. "Our medical team collaborates with physicians and researchers to constantly review the effectiveness of various medical treatments to produce high quality and safe outcomes. We also are committed to maintaining a robust network of providers so that our members can have access to affordable, evidence-based treatments and quality care. Depending on the member's plan, available providers may include Blue Distinction Centers that are recognized for offering quality care, treatment expertise, and better overall patient results.
"By doing so, we are being good stewards of our members' healthcare dollars while providing access to a wide choice of providers," Blue Cross Blue Shield said.
Giduturi has also contacted the U.S. Department of Labor for help.
"What Erika is dealing with is unconscionable," the Department of Labor said in a statement to Inside Edition Digital. "There’s no law preventing Zachry Group from doing the right thing. The Labor Department continues to engage with them and work toward a life-saving solution for Erika. She should not have to fight her husband’s employer at the same time she fights this disease."
The Department of Labor also said it is investigating the circumstances surrounding her treatment.
"We are extremely concerned about how Ms. Giduturi’s claim for urgently needed – and potentially life-saving – treatment has been handled," the agency said.
Giduturi hopes sharing her story impacts the next person who needs life-saving treatments.
"I want businesses to not have say over life-saving treatments," she said. "I know it's a, a stretch, and it's gonna be a probably won't ever happen, but I don't want other people to have to face the situations that I've had to face."
