Financial Triage

I saw a screaming headline on Raw Story, ‘Insurance Company to Starve Toddler.’ I thought it would be some heartrending situation where a baby was on a feeding tube and life support with a dispute between the family and the insurer and the hospital, etc. As I mentioned in the last post, ‘Desperately Fighting Big Insurance’, universal health care would not mean that everyone gets every treatment. There is a limit on resources. I was expecting to read the article with a sense of resignation to that fact. I never expected this…

YORKTOWN — Three-year-old Hannah Devane is allergic to food. Not the kind that makes kids spit out their broccoli; the kind that can kill.

The Yorktown preschooler has a condition called eosinophilic esophagitis, a severe food allergy that causes a type of white blood cell to congregate in the esophagus, the tube that carries food from the mouth to the stomach, damaging the tissue when she eats.

A doctor-prescribed formula has allowed Hannah to grow to a robust 40 pounds, a normal weight for a child her age. Without it, Hannah could wind up with a feeding tube.

But the insurance program that covers her family through her father’s job as a New York City police lieutenant has stopped paying for the formula, which costs $1,200 a month. Food supplements and other over-the-counter items are not covered under the family’s insurance, the prescription plan administrator said.

This is so FUBAR. I know that $1200 a month is a lot of money, but that money is keeping a child nourished and healthy. To force a child who can take nutrition by mouth to undergo surgery to insert a feeding tube is medically unjustified, and there’s no guarantee it would not be more expensive in the long run. You’d have surgery, hospitalization, follow-ups, treatment for complications and still have to buy formula. It costs about twice as much to keep someone in a nursing home for a month, to put the cost in perspective. And the parents are doing all they can do…

Since early November, when Hannah’s last case of insurance-covered formula ran out, her parents have spent about $300 a week on Elecare.

Michael Devane works a second job as a security guard to cover expenses. Jessie Devane works three times a week as a temporary nurse. Hannah can’t take her formula to day care. She is only permitted to drink water and eat the rice and pears her mother prepares for her. She is ravenous when she gets home, her mother said.

The family had been getting coverage for Elecare because of an error, said Helen Sweeny, the administrator of the self-insured medical benefits fund run by the Superior Officers Council.

“The program would be broke if we tried to cover food,” said Sweeny, who has run the program for 32 years.

My suggestion to Ms. Sweeny is to stick a label on the Elecare can that says…I don’t know… Ritalin or Viagra or Oxycontin or something. Then they can call it a drug and cover it.

I wish this was an aberration, but I regularly see patients who are getting sicker because their insurance doesn’t cover essential meds, and I’ve been trying to make sense of the maze of Medicare drug plans so my mother can get coverage at all.

When we finally get universal health insurance in this country, as we must, we will need to write in enough flexibility to cover the costs of keeping a child healthy, invest in the care that will lead to long-term savings, and not create illness because the system won’t change.