Insurance company sends letter to 9-month-old boy explaining he’s too expensive to keep alive
9-month-old Connor Richardson (Facebook.com)
A 9-month-old boy with an
aggressive brain tumor received a letter from his family’s insurance
company explaining that treating the cancer would be too expensive and
therefore “not medically necessary.”
‘Dear Connor Richardson,” the letter said,
according to The Daily Beast, “As HIP Health Plan of New York, we try
hard to provide you with access to quality health care services that
meet your needs. When we decide to deny coverage for treatment or
service, we want to make sure you know why.”
Connor’s father — retired NYPD officer Wayne Richardson — told The
Daily Beast’s Michael Daly that at 7 months old, his son had a
frightening crying jag late one night. The baby’s eyes popped open, wide
and staring.
“Not like a regular baby, like when somebody dies,” Richardson said.
Connor was diagnosed with a rare aggressive teratoid rhabdoid brain
tumor that was blocking blood flow to his spine. Doctors removed the
tumor, but the cancer returned.
St. Jude’s Children’s Hospital in Memphis, TN opted to place the baby
on a combination of four drugs plus an experimental medication in a
desperate bid to save his life.
“He’ll die if you don’t do it,” said Richardson.
However, the family’s insurer has deemed that the lifesaving
treatment is “not medically necessary” and warned Connor, “If you decide
to have this service you may have to pay it yourself.”
“When we reviewed the information given to us about this request, we
have decided to deny coverage of the following medical service(s) or
item(s) that you or your provider asked for: Inpatient Hospitalization
to St. Jude Hospital from 10/4/2017-10/10/2017. We have determined that
the service(s) are not medically necessary,” the letter explained. “This
letter is your Initial Adverse Determination. This means we are denying
your quest for coverage of the requested service(s).”
Then, in a bold-typed section, the company explained to Connor — as if he were his own child:
“Your child is a 9 month old boy who was diagnosed with a high grade brain tumor. Your child was treated with surgical removal of his tumor at Stony brook Hospital. After your son was discharged you enrolled him in a clinical trial at St. Jude’s hospital. The principal investigator has requested medications including methotrexate, cisplatin, cyclophosphamide, vincristine in combination with an investigational medication, alisertib. This combination of medications is not the standard of care for this type of cancer, and is considered experimental and investigational at this time, as evidence-based guidelines do not exist to confirm its effectiveness for his brain tumor. Therefore, this request for clinical trial treatment at St. Jude’s hospital is not medically necessary and is denied.”
Because the treatment is a clinical trial, it may not reverse the cancer’s growth. Therefore, HIP sees no reason to pay for it.
Fortunately for the Richardsons, St. Jude’s does not charge patients
for medical treatment, said Daly, and even provides families with
transportation to and from the hospital as well as food vouchers during
their stay.
Wayne Richardson said that he believes St. Jude’s should be paid the
denied funds, however, because it will aid the hospital on its mission
to help children and fuel further research.
“You’re taking away from them and their research…because the insurance doesn’t want to pay,” he told Daly.
“Wayne plans to contest the denial, and the letter does tell him how
to file an appeal,” Daly said. “Meantime, the insurance company will not
pay for the chance to save Connor’s life. And the money the company
saves will go in its coffers rather than toward treating and maybe
curing catastrophically sick kids.”
source : https://www.rawstory.com/2017/10/insurance-company-sends-letter-to-9-month-old-boy-explaining-hes-too-expensive-to-keep-alive/