Krista Corner Havre Daily News firstname.lastname@example.org
A local family won their battle with their health insurance provider last week, with the help of U.S. Sen. Max Baucus, but they still need help to pay for their portion of the procedure and travel expenses to Spokane, Wash. A benefit account has been opened at Independence Bank for those who want to help the family. Burlington Northern Santa Fe Railway electrician Mike Sheehan has health insurance through his work. However, his insurance provider, United Healthcare, initially refused to pay for a surgery that could restore his daughter Brooklyn’s hearing. The baby is completely deaf and doctors say a cochlear implant will help her to regain hearing, Sheenan said. Initially United Healthcare refused the surgery for a variety of reasons. Doctors told Sheenan that without the surgery his baby girl, Brooklyn, would be deaf for life. “Cochlear implants are expensive,” said Kim Ward, manager of pediatric programs at Sacred Heart Medical Center and Children’s Hospital in Spokane. “The main cost is $20,000 to $30,00 just for the device that doesn’t include the cost of the surgery.” Brooklyn was born on Jan. 19, 2007. At 5 months old, she became ill with bacterial meningitis. Brooklyn was flown to Benefis East in Great Falls and admitted to the Intensive Care Unit for two weeks. Staff at Benefis inserted a PICC line a peripherally inserted central catheter into her arm to deliver medicine directly to her heart, her parents said. Brooklyn also required a feeding tube, oxygen and a ventilator for her lungs. After Brooklyn was transferred out of the ICU, she continued to require medical attention. She started having seizures. Doctors, unable to stop them, put her into a drug-induced coma until an EEG machine showed the seizures had stopped, her parents said. Barely a year old, this little girl is now completely deaf. Dozens of different hearing tests later, doctors say hearing aids won’t benefit her because she cannot hear. They also say if Brooklyn were to have cochlear Implant surgery the last option available, she could hear, though not like people who’ve never been deaf. Sheehan and his wife, Kerri, thought they were protected. They thought if anything happened to them or their children, their insurance company would be there to cover the cost. Until Baucus and his staff stepped in, it appeared the family had thought wrong. Sheehan has worked for the railroad for the last two years as an electrician. As a benefit of his employment with Burlington Northern Santa Fe Railway, he said his plan outlines that he pay 15-percent of his health insurance premium to cover his entire family himself, his wi fe and two daughters, Madisyn and Brooklyn. His 15 percent comes to about $166 a month. BNSF pays the other 85 percent. “It’s around $1,000 a month total,” he said. Even at those prices, the Sheehans’ insurance company, United Healthcare, initially refused to cover the cost of the surgery, though Mike Sheehan said the plan is supposed to cover major medical, dental and vision. The family, at its witsend wondering how they’d pay for the devices, the surgery and traveling costs, spoke candidly with the Havre Daily News about their struggle. “It’s been stressful,” Mike Sheehan said. “They’ve been leading us on and when it seems like things are going to be OK, they send us another denial. I just talked to someone at work one lady thinks they should cover it at United from our new contract but they’ve told me that before, too.” The window of opportunity is closing for doctors to perform the procedure, Sheehan added, which has left him questioning the validity of the insurance denials. “With Brooklyn getting meningitis, her ears will ossify (transform from soft tissue to hardened bone) and close off. She can’t get the surgery after that. They’re not sure when that will happen, but it will happen eventually. “I wonder if the insurance company knows that?” he asked. “If they hold off on it enough they won’t have to pay for it because it can’t be done anymore.” “I (was) getting really frustrated,” Kerri said. “Brooklyn has been to several audiologists several different times. We’ve been through many tests in order for her to qualify, and she’s eligible. They think, when she’s so young, the younger you get them the better it is. “It’s very frustrating,” she added. “You pay for your insurance and you have to fight so hard for them to pay for things when they come up. We had to cancel her surgery already once and maybe again this time.” Fighting with the insurance company has also been confusing. Every denial letter said something different, and even though the parents said they had complied with all the requests for information, the insurance company continued found a way to deny them again. “It’s like every denial we get is for a different reason first they said the surgery wasn’t part of our plan,” she said. “The second denial said cochlear implants are not a covered benefit under the plan. With the third denial they had questions. They needed proof from her doctors that two implants were better than one, which were sent in. The last letter said it was an experimental surgery, it wasn’t approved by the FDA and it wasn’t life threatening, so we were denied.” The Sheehans decided to ask a senator for help. A staff member at the senator’s office told HDN that because of the efforts of Baucus and his staff, United Healthcare decided last week to approve payment for surgery to insert cochlear implants in both ears of 1-year-old Brooklyn. “It’s a happy thing,” the staffer said. “We’re very excited.” “I can’t believe it,” Kerri said. “We’ve been fighting this going on three months now.” Kerri said she sent an e-mail to confirm the good news to a contact at United Healthcare, however she didn’t really expect to hear anything back, because history with the contact had proven a no-reply-type of service. After Baucus’ office became involved, it seemed things would be different. “I kid you not, in less than 10 minutes after I sent the e-mail, she called me and told me both implants were approved.” Brooklyn’s surgery is scheduled for Feb. 28 and the family will stay at a motel in the vicinity of the hospital overnight, Kerri Sheehan said today. The estimated cost of the surgery, she added was $80,000, The Sheehans will have to contribute around $12,000 to the cost of the surgery. In addition, the family will travel to Spokane for two appointments next month scheduled for two weeks after the surgery and two weeks after the initial appointment. Travel costs for the family will add an estimated $1,000 to $2,000 to their total contribution. Donations to assist the Sheehans with medical or travel expenses, can be made at Independence Bank at 435 Third St. in Brooklyn Sheehan’s name.