Insurance Challenges Delay Reconstructive Ear Surgery for Minnesota Girl
MINNEAPOLIS – A Minnesota family faced a challenging battle with their insurance provider to secure approval for reconstructive surgery for their daughter, Olivia, who was born with microtia, a condition resulting in an underdeveloped ear. The case highlights a growing trend of insurance denials for this type of surgery, leaving families to navigate complex appeals processes and potentially notable financial burdens.
Microtia affects approximately 1 in 10,000 births annually in the United States. While reconstructive surgery can dramatically improve a child’s quality of life, offering both functional and cosmetic benefits, obtaining insurance coverage is becoming increasingly challenging. Olivia’s family’s experiance with Anthem Blue Cross and Blue Shield underscores a recent surge in denials and overturned approvals for “gap exceptions” – necessary when a procedure falls outside standard coverage – according to Dr. Jennifer Lewin, a leading microtia surgeon.
Dr. Lewin, who performs around 120 microtia surgeries each year, noted a significant shift in approval rates. In 2024, over 90% of her Anthem patients’ gap exception requests were either approved or successfully overturned after initial denial. However, in 2025, Olivia’s case is the sole exception; none of Dr.Lewin’s other Anthem patients have received approval. “It’s just become kind of a very slow trend that’s very much peaked in the last year,” Lewin said. “It’s been rough, and we’ve had to work much harder to get a negotiation agreed upon.”
Anthem Blue Cross and Blue Shield has not responded to specific questions regarding Dr. Lewin’s claims. However, the company stated it is reaching out to Dr. Lewin to discuss a potential in-network arrangement.
Despite the initial hurdles,Olivia recently underwent the surgery and was able to see her new ear for the first time. While the financial details are still being finalized, Olivia expressed optimism about the future. “When it’s fully recovered, I’m gonna be like, ‘OK, that was just a short little bump,’ and then I’ll just go on with the rest of my life,” she said.
