<div>Asking for help isn’t easy, but I’m facing a big challenge and could use your support. On June 3rd, I’m scheduled to undergo a complex 8–14 hour surgery in California to remove a Vestibular Schwannoma, also known as an acoustic neuroma—a rare benign tumor growing in my right ear canal. For more information on the tumor, you can see more <a href="https://www.anausa.org/" target="_blank" rel="noreferrer noopener">here</a>.
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<div>Insurance has denied my surgery. I'm currently fighting the denial with appeals. But to get the surgery out of pocket is $76,000 with half up front. I hope the my appeal gets approved, but until then, I want to make sure I am ready for a possible out of pocket approach.
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<div>The Vestibular Schwannoma is in a place where it’s affecting four nerves, auditory, balance, facial and a cranial nerve. As it grows (1mm per year) it will start to press into my brain stem causing additional issues.
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<div>The surgery I'm scheduled for is called a Middle Fossa approach, is my best chance to preserve hearing in my right ear. We won’t know the outcome until I wake up.
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<div>Because I’m self-employed and don’t have paid time off, I’ll likely be out of work for up to three months during recovery.
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<div>I’ve chosen one of the best surgeons in the country, and I’m hopeful for a smooth recovery.
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<div>My appeal letter to the insurance company:
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<div>To Whom It May Concern:
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<div>I am writing to formally request a review of your denial of the claim for treatment/services provided by Rick Friedman on 4/3/2025.
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<div>The denial was issued with the reason stated as Out of Network. However, upon reviewing the details of my health insurance policy, I believe that the treatment/service in question is indeed a covered benefit under the plan. According to the policy documentation, services are covered when they are deemed medically necessary.
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<div>The goal of my treatment is to preserve my hearing through the Middle Fossa approach, which was both medically necessary and recommended by a licensed healthcare provider. After extensive research and consultations with five (5) leading specialists across the United States, I found that Dr. Friedman at the University of California San Diego (UCSD) has the most successful track record in hearing preservation using this approach.
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<div>In addition to his expertise, Dr. Friedman’s surgical outcomes demonstrate significantly faster recovery times, shorter durations under anesthesia, and reduced hospital stays compared to other specialists I considered. These factors are particularly important for both my health and my ability to return to work promptly. Being self-employed does not provide the benefit of paid time off, vacation or sick time, so the recovery process is also something I take into consideration.
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<div>As a self-employed individual residing in Kansas City, Missouri, my insurance options are limited, and none of the available plans include Dr. Friedman as an in-network provider. The initial onset symptoms were going deaf in my right ear. Being in the field of audiology, I contacted my primary care physician and he escalated the issue. With the findings from the Audiologist, I was referred to an Otolarangologist. I was treated with 3 steroid injections into the ear drum over the course of 10 days to recover my hearing. These injections were successful. I have attached my audiology reports to show the loss and treatment. MRIs have shown a growth in my Vestibular Schwannoma of a rate of 1mm per year. This rate is slow, but the growth will continue and cause irreparable damage if untreated.
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<div>The local specialist in Kansas City has performed approximately ninety (90) of these surgeries over the past ten (10) years. Based on publicly available data it appears that these procedures were typically conducted only after significant or complete hearing loss had already occurred. In contrast with Dr. Friedman, my objective is to preserve my hearing before that level of deterioration occurs. With my research, Dr. Friedman does hundreds of these procedures a year, making him one of the leading surgeons in the country. From the data, his statistics are as follows: 2019, 244 procedures. 2020, 153. 2021, 230. 2022, 250. 2023, 153. 2024, 180. As you can see, Dr. Friedman and his staff are top in the nation when it comes to this tumor. His expertise and experience plays into my decision to have him perform the Middle Fossa approach for hearing preservation in my right ear. As a self-employed sign language interpreter, my ability to hear is vital to my profession and livelihood. For this reason, I chose Dr. Friedman and his team at UCSD. Their proven success rates in hearing preservation, combined with superior outcomes in surgical and recovery metrics, made them the best option for my specific medical needs.
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<div>Given the medically necessary nature of the procedure, the clear clinical advantage of being treated by Dr. Friedman, and the critical importance of hearing to my profession, I believe the most appropriate course of action is to proceed with the Middle Fossa approach at UCSD.
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<div>For your reference, I am including the following documents with this appeal:
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<div>A letter of medical necessity from the treating physician
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<div>Member complaint and appeal form
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<div>History of hearing loss due to the Vestibular Schwannoma and the audiology reports after receiving treatment to save the hearing.
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<div>Initial denial letter dated 4/3/2025
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<div>I am requesting that you reverse the denial and approve the procedure, Middle Fossa, with Dr. Friedman at UCSD.
</div>

Roy Vombrack

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Mick Archer

Peige's brain surgery to remove a Vestibular Schwannoma

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Peige's brain surgery to remove a Vestibular Schwannoma

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