So sorry this is happening to your cousin. And, I didn't read the other responses so I aplogoze if I've repeated anything.
I don't know about PA laws, but I'm very familiar with workers' comp and health insurance in CA. (I'm a licensed, but non-working agent).
In my opinion, the first thing your cousin should do is talk to her doctor about getting her on state disability. I realize she tried to go back to work, I'm guessing because they need the money, but let's face it, she had a stroke due to a tear in her heart that needs to be repaired. I broke my right leg doing yardwork and was placed on state disability until I was healed up enough to be able to drive, etc. Her condition is far more serious. Again, I'm not sure about PA, but in CA, disability pays far better than unemployment. That will get some money coming in and help with her stress levels while she is under her doctor's care and she appeals to get her procedure paid for, etc.
Now, as for Worker's Comp, I completely understand why they would deny the claim. At least initially. If she can prove that the tear in her heart occured as the direct result of something she was doing at work, such as lifting a patient that was too heavy or something heavy falling on her, that might be one thing. Something occuring at work and being a work related injury or illness are very different things. So, she's got that to consider.
Now, as far as unemployment, it's my guess that they are denying her because she voluntarily said she would find somewhere else to work. That's voluntarily quitting, which unemployment insurance will deny a claim for. She can argue that she took their not being willing to accomodate her re-entry as being terminated, but the employer may say, "We weren't comfortable with her coming back to work just yet."
The other thing about unemployment is that you cannot be too sick or injured to work or look for work. If the employer tells them she's recovering from a stroke and in their opinion tried coming back to work too soon, DENIED. Which again is why she needs to speak to her doctor about state disability and discuss with her when she may or may not be actually released to return to work. With something as serious as this, it shouldn't be up to her necessarily, she's not been repaired yet.
Hopefully she hasn't burned any bridges with her employer and once she's released to resume normal activities at work, they'll be happy to take her back when she's well enough.
As far as insurance, and I don't know what carrier she has, (some are definitely better than others), she could just be caught up in the "you pay, no.....YOU pay" vicious cycle to the point a third person just said, to heck with it, let's call it too experimental. Personally, I don't see how she will get worker's comp to cover this as upsetting as that may sound so she should focus on getting a case manager assigned to her claims, etc with her private health insurance so everything is with just one person, in one department. If her cardiologist has gotten this procedure approved for someone else through the same insurance carrier, without violating the privacy of the other person, that needs to be pointed out. Having said that, keep in mind that a procedure that's been done dozens of times before, doesn't mean it's covered by an insurance policy. One example is that some policies will cover gastric bypass surgery and others won't. It doesn't necessarily mean it's because it's experimental, it may simply mean there is no provision in the policy for it or it's clearly excluded as not covered. What she needs to get her hands on is an "Evidence of Coverage" booklet if she doesn't already have one, which in essence is the very long drawn out booklet that outlines coverage, your rights and responsibilites under the policy, etc.
As far as the appeals, if you keep approaching things from the same angle, they will keep getting denied from the same angle. I'll give you a couple of examples:
A client, an attorney of all things, was having trouble and getting her medical claims denied. She had an agent helping her, but the agent just kept submitting the bills and time after time they were denied. 10 months later, she brought this huge folder of stuff for me to try to figure out. It took me less than 10 minutes to figure out what no one at another agency OR at the insurance company had noticed. She was a 53 year old woman and someone at the doctor's office had submitted the bills with a diagnosis code for infants. She clearly was not an infant and didn't even have an infant on her policy, so the claims were just denied as a matter of course. All the doctor office had to do was resubmit the claims with the proper code and all her back claims were paid.
A client's little boy was playing with his cousins and got hit in the face with a toy. He had to go to the emergency room not only for his facial injuries, but a pediatric dental specialist was called in due to damage to his teeth and gums. They got him fixed up and the little boy, although pretty seriously hurt, was going to be okay. The insurance carrier took one look at the claims from the dentist and denied them because "there are no dental benefits under the health insurance policy."
Someone sitting in a claims cubicle simply saw claims from a dentist and automatically denied the claims. They clearly didn't look at the procedure or diagnostic codes or they would have known that the claims were for physical trauma to the mouth related to a medical emergency. It took getting the right person to sit down long enough and look at the claims to get them paid. And they WERE paid.
So, just another thing to throw out there if for her doctor to check the procedural and diagnostic codes included in the request for authorization.
Also, check to see if her cardiologist is not a preferred provider for that insurance carrier in which case they can request an "out of network referral".
No offense to her doctor, but contacting congressmen? I'm pretty sure they're on vacation right now.
I'm sorry this is getting long.
I think she needs to take a deep breath. Have her doctor get her on state disability. Forget about unemployment for now. Forget about worker's comp for now. Get a copy of her policy. Find someone that knows about insurance coding. It may be that it needs to be coded in such a way that shows it's follow up for her stroke and not something they just out of the blue decided she needs to have. She knows the name of the procedure, have her look it up to see if it's considered experimental.
All I know is, it sounds like appealing and appealing has garnered the same results so a new approach is necessary and I would start with the insurance carrier. There are ways to get things done.
I really wish her well. Stressing about all this isn't helping her.
Best wishes.