Monday, January 28, 2008
Help Me Howard: Feeding Tube
Unfortunately not everyone has it, but if you do have health insurance, you would hope it works for you when you need it most. That's of course not always the case. One family says their insurance company is letting them down not paying for their son's feeding tube. Here's Help Me Howard with Patrick Fraser.
WSVN -- Ronald Vasquez: "There you go, play the drum."
They say nothing in life is perfect. That is, unless you're a parent.
Ronald Vasquez: "He's a great kid. He has a sense of humor, a great character, nothing more I can say about him. I mean, to me, he's perfect."
Ronald and Melanies' 5-year-old son Danny has cerebral palsy. A tough hurdle to overcome but Danny does it.
Ronald Vasquez: "Danny is always on the go. You have to be behind him. I mean, your house could be clean one minute and the next minute it could be a mess."
Both take care of Danny and both work to pay the bills, including the health insurance to get Danny what he needs.
Ronald Vasquez: "Always in the hospital, a lot of doctor visits. Danny had severe acid reflux. He always spit up, no matter what he ate, so he started to lose weight because of it, so they had to do surgery."
Now nutrients flow directly into Danny's stomach, through a tube that hangs out.
Ronald Vasquez: "Wow, it's expensive. I mean the formula costs me around $100 to $200 a month. That comes out of my pocket."
Ronald pays for the formula and the insurance company is supposed to pay for this mic-key, the device that regulates the flow of nutrients. It costs a couple of hundred dollars each month or so, but the supplier of the mic-key says the insurance stopped paying for it last year.
Ronald Vasquez: "They told me that since the insurance is not paying for it, they don't want to supply us anymore with them because they are not making any money off of it."
So Ronald called his insurance company. They told him, "We are paying the supplier," they said, "No, you aren't," and guess whose life is stuck in the middle?
Ronald Vasquez: "If you don't have the mic-key button, without that, I mean, you don't survive. That's the bottom line. Without that he can't eat. He doesn't survive."
It's a horrible situation for a parent. Their child needs a life-saving device, but their insurance company won't pay and, Ronald says, doesn't seem to care. Frightening and infuriating.
Ronald Vasquez: "It let me down. Everyone has let me down. I'm angry. I mean, that's why I'm going through this, because I'm angry."
But what can you do when it seems your insurance company is not paying? It's a question we get a lot. Howard, got an answer?
Howard Finkelstein: Insurance companies have to pay for whatever they have contractually agreed to pay for. You can find that information in your policy. If they have agreed to pay for, and are not, complain, complain, complain to them, to the state and, if that fails, contact the media, but never give up."
When we talked to the insurance company they placed part of the blame on the company Danny gets his device from. Saying they were slow to bill them, but they also accepted part of the blame, admitting they were slow to pay for the device. They added this was a confusing case. It shouldn't have happened, and it won't happen again. Danny now has the device he needs. It's paid for, and for everyone with insurance, it's a warning.
Howard Finkelstein: "Go get your insurance policy now, read it carefully so that you are not surprised at a time when you are sick and not able to fight back. Fortunately, Danny has his parents to fight for him, but many adults don't have anyone to fight for them, so get it cleared up before you get sick."
Fortunately, this insurance problem is solved for Danny, but his parents have to stay on their toes because there will probably be more insurance headaches to deal with.
Ronald Vasquez: "I always have to worry about my son, but at least now, on the feeding-wise of him getting his feedings and all that, I'm just glad that is taken care of, and he gets his feedings, and everything will go as well."
Now, if you are having problems with your health insurance and calling and complaining doesn't work, you can call the state. Not only can they help you, in some cases they can force the insurance company to pay. Give them a call, get all the help you can get.
Got a problem you care about but find no one cares to hear about it? Contact us. We can assure you we will insure you get what you deserve.
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CONTACT: helpmehoward@wsvn (please include your contact number when emailing)