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More than 30 years ago, Dawn Thurman received the gift of life. Now she needs another miracle, but both Medicare and Medicaid stand in her way.

After giving birth to her son, Joshua, Dawn was diagnosed with an enlarged heart and told she needed a transplant. After a four-hour surgery in September 1988 at the University of Iowa hospitals, she became the hospital's 24th recipient of a heart transplant.

"It's just a miracle, the whole thing, the way everything happened," her father, Jerry, told the Quad-City Times at the time. "God did it. That's all there is to it." 

Now, Dawn needs another miracle. She is in failing health and her doctors say she needs a new heart and a kidney. But her insurance company, responsible for paying for part of the surgery, hasn't approved payment.

"We’re waiting. All we’re doing is waiting. And as we wait, every day she gets worse," her mother, Judy, said in late August.

Failing health

Dawn's new problems began in May when her legs began to swell. Her doctors in Iowa City discovered a leaky valve in her heart. "[That valve] turned into all three of the valves leaking because they didn’t fix the first one when they were supposed to," Judy said.

Her doctors had decided it was too dangerous to perform the surgery, Judy said.

Dawn was transferred to the University of Madison, Wisconsin, hospitals. Her insurance covered this, and doctors there determined she needed a new heart.

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"They go through your whole body. Two weeks of testing, all sorts of tests," her father, Jerry said. "They make sure everything’s okay. They’re not going to waste an organ on someone that’s not going to last."

But the procedure is different this time because Dawn has been on anti-rejection medicine for almost 31 years. And she needs two organs, not one.

Insurance delays

Dawn has been waiting five weeks for the surgery. She thought Medicare and her Medicaid insurance provider, Amerigroup, would each pay for a portion of the surgery, and she would pay for the rest. But neither has responded to their questions. And it's been weeks since the Thurmans contacted Madison, who said they would reach out to Medicare to solve the problem.

When the Times called, Amerigroup referred calls to the Iowa Department of Human Services. Department of Human Services spokesman Matt Highland said they cannot comment because of patient privacy laws.

"So Madison has been dealing with Iowa City and Amerigroup and nobody can get answers. And meanwhile, that five weeks she just keeps going downhill," Judy said.

"Why would you refer her out-of-network, do an evaluation and then not do the surgery?" Jerry asked.

"And they paid that," Dawn added.

"We wait for that phone to ring every day," Judy said. 

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