Wednesday, July 25, 2012
Help Me Howard: Needs Prescription Formula
The greatest thing in the world is a child. One of the worst things is a child that is in pain. For one South Florida boy, that happens if he tries to eat food. One solution is a prescription, but the family's insurance company won't pay for it. So they called Help Me Howard with Patrick Fraser.
WSVN -- If you have ever been lucky enough to have a baby, you know how Mercy feels.
Mercy Arce, Son Needs Prescription Formula: "Life changing, life altering, soul altering. He's my love, you know. He makes everything better."
As Matthew took his first steps, he was a perfectly healthy baby, and he is still an energetic and playful little guy.
Mercy Arce, Son Needs Prescription Formula: "I still feel like, Wow, I'm a mom. I'm his mom."
But when Matthew turned 4 months old, a memorable event for most parents was terrible for Matthew.
Mercy Arce, Son Needs Prescription Formula: "At 4 months, after feeding him some cereal, about three hours or so after, he started vomiting. It didn't even sound like my baby. It just sounded like a grown man was vomiting."
Matthew was rushed to his pediatrician, where Mercy and her husband were told he had a virus.
He got better. A few weeks later, they again tried to feed him baby food.
Again, he got horribly sick and was rushed to the doctor.
Mercy Arce, Son Needs Prescription Formula: "I told them that I was very concerned, that it didn't seem like a normal baby vomiting, that it seemed more severe. And I was told, 'Oh, are you a first-time mom?'"
Mercy's motherly instincts were right. The doctor was wrong. A few months later, Matthew's grandmother gave him a spoonful of baby food. Mercy got the call at work.
Mercy Arce, Son Needs Prescription Formula: "She called to tell me that he had passed out. I rushed over. I got here, he was not responding."
Matthew's little body was vomiting so hard, he passed out. He recovered. Then Mercy started taking him to various specialists, where one discovered he had terrible allergies.
Mercy Arce, Son Needs Prescription Formula: "She prescribed the Elecare."
Elecare is a prescription formula that a child with severe allergies can drink to get the nutrients he needs. Mercy dropped the prescription off at a pharmacy.
Mercy Arce, Son Needs Prescription Formula: "When we went back to pick it up, they told us that it was not covered under our insurance, and for a month's supply, it would be $1,600."
Mercy contacted United Health Care.
Mercy Arce, Son Needs Prescription Formula: "And they just, they were very dismissive. In fact, they were kind of rude. They told me that it wasn't covered, that it wasn't under our policy."
She filed an appeal that Matthew can't eat food, only drink the prescription formula Elecare.
The insurance company rejected her again.
Mercy Arce, Son Needs Prescription Formula: "I'm not asking for my insurance company's pity or sympathy. I'm asking for them to do what's right."
She found out the government pays for Elecare for poor families. Since she and her husband have jobs and work, they don't qualify.
But they aren't rich, and are living paycheck to paycheck to pay for Matthew's Elecare.
Mercy Arce, Son Needs Prescription Formula: "Heaven forbid if one of us were to lose our jobs or something were to happen that we couldn't provide this for my son. It's his sole form of nutrition."
Well Howard, several states have passed laws requiring insurance companies to pay for this special prescription formula. Can an insurance company in Florida say, 'We won't'?
Howard Finkelstein, 7 News Legal Expert: "Florida has a law that requires insurance companies to pay for some medical conditions that infants have. But they are not required to pay for the formula for Matthew's condition."
We contacted United Health Care. They told us, 'We have not received any clinical information that demonstrates the member meets any of the state-mandated criteria set forth by Chapter 627 of Florida statutes.'
In other words, by law, they aren't required to pay for Matthew's prescription formula.
A doctor did determine that Matthew is allergic to protein, which is found in most foods.
Mercy and her husband are now letting the 19-month-old Matthew taste different foods to try to find something he can eat, but he has become afraid of what food does to him.
Mercy Arce, Son Needs Prescription Formula: "So it's very difficult to feed him, to introduce a new food, because he won't take it."
Food is such a great thing, but a horrible thing in the eyes of this little boy.
Mercy Arce, Son Needs Prescription Formula: "I tell my husband all the time that if I could wake up tomorrow and it would be me that can't eat and allow him to eat, I'd be perfectly fine with that. It's just heartbreaking."
Patrick Fraser: "A few years ago, we did a story about insurance companies refusing to pay for helmets for babies who develop flat heads. After our story aired, a good legislator got the law changed to require insurance companies to pay. Parents have thanked us for that story. Maybe a South Florida legislator will get the law changed to help children like Matthew."
A feeding frenzy left a bad taste in your mouth? Want us to chew on some alternatives? Contact us. We have the formula for solutions, and you don't need a prescription. Just a phone call.
CONTACT HELP ME HOWARD:
EMAIL: email@example.com (Please include your contact phone number when emailing)
REPORTER: Patrick Fraser at firstname.lastname@example.org