Wednesday, December 12, 2007

Insurance companies suck

Baby is now about two months old and doing well. But these first two months have been an adventure.

Baby was breastfed for the first few weeks, but she lost nearly a pound and she had blood in her stool so her pediatrician recommended stopping the breastfeeding and put her on a hypoallergenic formula at about $25 per 16 oz. can. She gained some weight but she was still in terrible pain with each feeding so after a few weeks her pediatric gastroenterologist changed her formula to Neocate which costs $135 for a case of four 14 oz. cans. Right now we are using a can of Neocate every two and a half days.

We tried to get our insurance company to help with the cost of the formula. I called the insurance company and they told me that infant formula is not covered. I called Health Advocate the next day and they talked to the insurance company and again they told me that infant formula is not covered unless the baby has one of four conditions that they are required by state law to pay for formula--she does not have one of the four--and they told me to have her primary care physician (PCP) put through a pre-authorization request for the formula. The PCP's nurse called me back the next day and told me that they got a fax from the insurance company saying that infant formula is not covered. I called my wife's employer's benefits office who called the insurance company and got the same response.

Next, I called my state representative. His office took the information and contacted the state insurance department and they got back to me and said that there is nothing they could do to help. The representative's office suggested calling the manufacturer to see if they have an assistance program and if all else fails to call the county assistance office to apply for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). We called the manufacturer and they had no program. So I called the county assistance office and they said that I should apply for Medical Assistance for Baby and then if she gets that she will automatically qualify for WIC based on medical need even though we don't qualify financially. So I filled out the application online and dropped off a stack of documents. They called me back a few days later and said that Baby qualified for Medicaid and that we should call the WIC office to set up an appointment. A few days later Baby got her gold card in the mail and we have an appointment with WIC in a few weeks.

I think it is a crime that insurance companies get away with this crap. We pay about $1,000 a month for health insurance and they won't cover something that my baby needs to to survive. I was hoping that they would at least cover some of the cost since the Neocate costs two or three times the cost of regular formula. Baby has multiple food allergies (including cow's milk and soy) and that was causing colitis and keeping her from gaining weight. She also has Gastro Esophageal Reflux and she was in terrible pain during and after eating. Shortly after she started on Neocate she gained weight and the colitis went away.

Insurance companies in the United States cover only healthy people. Old people, poor people, and people with health problems have to get health insurance from the government. If it were up to me I would like to see everyone in the US covered by a national health plan and do away with private, for-profit health plans. Right now these for-profit plans collect thousands of dollars in premiums for people who are basically healthy and then when they incur healthcare expenses the insurance company does everything in its power to deny coverage.

So now I have to swallow my pride and take my daughter in to the WIC office so she can get her monthly supply of formula. But she is now thriving and we won't have to go into debt to feed her.

1 comment:

Anonymous said...

That sucks Rob, keep fighting.

- David