A toddler in Oklahoma has severe allergies. He requires a specialized prescription baby formula in order to be able to get the nutrition he needs. Aetna refuses to cover the cost of the prescription formula. This means his parents have to cover the entire cost of it out of pocket.
This is the type of story that makes health insurance companies look bad. It is these type of situations that emphasize that a particular insurer only cares about their own profits, and isn’t very interested in covering things that improve the health of the people who are covered by a health insurance policy. It almost doesn’t matter which insurer is behaving badly. Their bad actions reflect on the entire industry.
There are a lot of toddlers, all across the nation, that drink baby formula. There are a few different varieties to choose from. Enfamil and Simulac are two popular brands that immediately come to mind. The majority of toddlers don’t have any physical problem digesting baby formula. Most parents can rest assured that the bottle of baby formula that they give their toddler is a good way to help their toddler to get the nutrition that he or she needs.
That is not the case for the parents of Jackson McCook. This two year old is allergic to pretty much every variety of milk. This means that his body cannot properly digest milk. If you cannot digest a particular type of food, then your body cannot get any nutrition from that food. Typical baby formula, that can be purchased off the shelves at grocery stores, contains milk.
This means that Jackson needs to have a specialized baby formula in order to get the nutrition that a growing toddler needs in order to stay healthy. The type he can digest is only available by prescription. This means that a doctor feels that this particular baby formula is medically necessary for Jackson. It costs his family $450 a month.
Jackson’s family has health insurance coverage, through Aetna. The problem is that Aetna refuses to cover the cost of Jackson’s prescription baby formula.
The insurer considers the formula to be a food, and not as something that is medically necessary for the toddler. Their policy specifically states that they will only cover special medical foods that are taken orally when “mandated by state law”.
So, Jackson’s parents have taken their fight to the Capitol. There is a bill in the Oklahoma Senate called Senate Bill 1438. The bill, if passed into law, would require health insurance companies to cover the cost amino acid-based prescription formulas, (such as Elecare), regardless of the delivery method.
However, the progress has been stalled at the Insurance Committee. Senator Bill Brown is the head of that committee, and he says that he does not like insurance mandates. He wants the insurance companies to decide, on their own, to do what is right. Meanwhile, Jackson’s family is paying out of pocket for the baby formula that he requires, (despite having health insurance coverage).
Image by nerissa’s ring on Flickr