Mom Calls NBC 5 After Insurance Denies Coverage for Son's Treatment - NBC 5 Dallas-Fort Worth

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Mom Calls NBC 5 After Insurance Denies Coverage for Son's Treatment

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    NEWSLETTERS

    Insurance Agrees to Pay for Care After NBC 5 Responds Call

    Most parents are willing to do anything to make sure their child is healthy. But a couple in Bedford said an insurance company was standing in the way of getting their son the help he needs. (Published Thursday, Oct. 25, 2018)

    On June 2, 2017 Allison Scott gave birth to her second child, Shepherd.

    "Healthy baby. Big baby.  I didn't have any issues in the beginning," she said.

    But as Shepherd got older, feeding time became increasingly challenging.

    At six months, she and her husband realized something wasn't right with their baby boy.

    "Anytime I fed him, about two hours later he would start vomiting and turn limp and very cold," Scott explained.

    After several emergency visits, Shepherd was diagnosed with Food Protein-Induced Enterocolitis Syndrome or "FPIES."

    It's a rare disorder that affects the gastrointestinal tract.

    Shepherd's symptoms eventually developed into to an oral aversion, causing him to fear food and reject eating.

    Doctors said if progress wasn't made, he could be looking at a feeding tube.

    "It's hard. You don't want anything to be wrong with your child, so I just said I have to get him help. I have to help him figure this out," his mom said.

    Shepherd was referred to an inpatient feeding program at Our Children's House in Dallas.

    Mary Fink, who oversees the program, met with the Scotts to learn more about their son's condition.

    "He had severe diarrhea, severe vomiting, so he was losing weight," Fink said.

    Shepherd was then seen by five doctors at Our Children's House, who each recommended him for the program.

    At Our Children's House, Shepherd would work with a number of professionals including a speech therapist to help with his oral motor skills and mouth muscles; a dietitian to examine Shepherd's allergies; an occupational therapist to look at the support Shepherd's body provides while he's eating; a psychologist to address his fear of food.

    Their goal: Helping Shepherd break his old eating habits.

    "We look forward to the challenge and with our team's expertise he should make some progress," Fink said.

    Scott was anxious to get her son into the program, but earlier this month she received a letter from Cigna denying coverage they determined to be "not medically necessary."

    "What do you mean it's not medically necessary? We have all these doctors saying it is and all of these people fighting for him to get in this program and insurance is the only thing standing in the way," she said.

    Scott refused to give up on this program, so she called NBC 5 Responds hoping that I could help her son.

    I reached out to Cigna to find out why Shepherd's coverage had been denied. Cigna didn't immediately get back to me, but Scott said she got a call from Cigna a few hours after I reached out.

    "I was just ecstatic. I just started crying," she said.

    She learned that Cigna had overturned its decision and her son's treatment would be covered.

    "I'm thrilled that he's going to get the help that he needs," said Scott.

    For the next 21 days, the Scotts will call Our Children's House their home.

    "I'm so grateful," Scott said. 

    Shepherd still has a long way to go in his dietary journey, but his parents are determined to support him every step of the way. 

    "He gives me the motivation to get him what he needs," Scott explained.  "He's the best little guy."

    Cigna told me in this case, its role was to review the medical service request to ensure that it was consistent with evidence-based medical guidelines.

    Cigna said its medical directors spoke with the family's doctor to get more information, and this allowed them to certify the medical need for treatment.

    So, in this case, problem solved.

    Shepherd has been in the program for two week now.  His parents tell me that he's already making progress.

    Scott was told this program could have cost her family $100,000 out of pocket, which would have been a great hardship. She's so happy that she decided to call NBC 5 Responds.

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