Mother Battles State for Son's Insurance Coverage After What She Calls a Preventable Tragedy - NBC 5 Dallas-Fort Worth

Mother Battles State for Son's Insurance Coverage After What She Calls a Preventable Tragedy

"We are talking about human beings, we are talking about children"

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    Mother Battles State for Son's Health Insurance Coverage

    A Mesquite mother battling a state contractor to get insurance coverage for her adopted son addressed lawmakers at the Texas State Capitol Wednesday in hopes what she called a preventable tragedy like her son's never happens again. (Published Wednesday, June 27, 2018)

    A Mesquite mother battling a state contractor to get insurance coverage for her adopted son finally had her days in court.

    Linda Badawo argued the contractor's partial denial of coverage triggered a catastrophic accident that left her son in a vegetative state.

    Wednesday, she addressed lawmakers at the Texas State Capitol in hopes what she called a preventable tragedy, like her son's, never happens again.

    Badawo wheeled her adopted son in to testify by her side. On their way up to the microphone they passed the CEO and Medical Director of Superior Health Plan. The managed care agency she blames for her son D'ashon's vegetative state.

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    "It's been a tough morning since after the last hearing. It's been like everything just coming back, and I hope I can present my case. I hope I can make you guys understand what I'm going through," said Badawo.

    D'ashon and his twin sister D'asia were born three months early. Both had marijuana and cocaine in their system.

    When Badawo took them into her foster home, doctors predicted D'ashon would grow to be a healthy boy. But when he was about a year old, D'ashon started pulling out his breathing tube.

    His doctors, nurses and child welfare workers copiously documented the problem. Badawo repeatedly asked Superior to increase coverage and give D'ashon a private nurse 24 hours a day.

    They denied her requests. Instead they told Badawo to restrain his arms with a soft splint. She refused, telling Superior it would be illegal without a doctor's order -- which she didn't have.

    When D'ashon was 14 months old, he pulled out his breathing tube. It happened when he didn't have his own nurse, and when Badawo was out of the home.

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    By the time he got to the hospital doctors declared him brain-dead. Now, he requires feeding and breathing machines to live, and dozens of drugs just to keep him stable.

    Testifying Wednesday, Badawo said she tried to convey one simple message about Superior Health Plan.

    "I want them to be out of the system! We are talking about human beings, we are talking about children," she said. "We are talking about fragile medical needs kids that needs this care more than anything."

    Texas state lawmakers are now investigating if changes need to be made to the state's managed care system.

    On Wednesday, surrounded by many of the kids they create plans of care for, the CEO of Superior Health Plan, Mark Sanders, answered lawmakers' questions.

    "I thought care coordination was the big selling point behind managed care isn't that part of what you're supposed to be doing?," Republican Rep. Sarah Davis asked.

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    "We do coordinate that coverage services we do make efforts to follow up on Medicare providing those services, but as I mentioned it's a much more manual process," Sanders said.

    Then Republican Kevin Roberts asked Superior's Medical Director David Harmon to explain how care choices are made.

    "It's based off of clinical policies that are developed based on requirements in our contract," Harmon said.

    Before the hearing at the state capitol, Badawo retained legal counsel. She told NBC 5 she intended to take legal action against Superior. While the company's CEO and medical director spoke at the hearing, they declined NBC 5 requests for an on-camera interview.

    Read more about D'ashon's case, or other kids in the managed care system from our media partners at The Dallas Morning News by clicking here.

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