By in Health & Fitness

Prescription Nutrition

I have been following a petition on change.org created by a woman with a three-year-old daughter who relies completely on prescription nutrition to survive. Due to her medical condition, she cannot eat. The problem is, the parents' health insurance won't pay for the formula and it is pretty expensive. The mom says it costs her about $1,400 a month.

Because both parents are employed, they can't get government assistance so they struggle to pay for the nutritional formula for their little girl. The petition has been up for a while now and has about 200,000 signatures but United Healthcare hasn't reversed their opinion.

Before I started writing full time, I worked for two different insurance companies. I went through a pregnancy with both companies. When I worked for Humana, the head of the customer service department gave me a hard time about taking time off to go to the doctor. When I need Zofran to prevent dehydration, Humana offered me ten pills every month. My doctor filed an appeal for me and they gave me 12. Fortunately, my doctor had samples and gave me all she had to keep me out of the hospital.

With my next baby, I worked for United Healthcare, the same insurance company the woman with the little girl who needs prescription formula has. I was hospitalized six times in first five months of my pregnancy for hyperemesis. United Healthcare was more generous than Humana and gave me 40 Zofran pills a month. They had no problem paying for me to be in the hospital for two days at a time when I got dangerously dehydrated though.

In my experience, insurance companies' decisions are not made by real people with real illnesses. To get what you need from your health insurance, you have to know how to work around their policies. According to the petition, there are 10 states that mandate insurance companies to pay for formula. If I was the mother in the petition, I would move.


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Comments

Ellis wrote on July 22, 2014, 8:25 PM

For all its faults the NHS would meet the cost of prescription for this child if she was a UK resident...it seems to me the bottom line here is profit first and patient care second...

MsTina wrote on July 22, 2014, 9:44 PM

Pretty much. They have "guidelines" and "exclusions" that keep people like this family from getting what they pay for. Health insurance is expensive and despite the fact that the parents could get public health insurance to cover the cost of the formula if they made less money, they might not get the quality of care their little girl needs for her medical conditions.

gidget wrote on July 22, 2014, 10:38 PM

What's worse is, that the insurance people who review the medical records have no health care experience whatsoever.
I am majoring in Alternative Medicine and am on a lot of pills for various reasons. My goal is to replace all of those with herbal medicine.

MsTina wrote on July 23, 2014, 7:17 AM

I worked in the self-funded dental department of UHC. I had absolutely no dental experience and neither did four of the six people in our department, including the boss. There wasn't even a real handbook. If there was a question, a woman from the medical claims department whose husband was a dentist made the final decision.

kdarrell wrote on July 23, 2014, 11:34 AM

Yes I think I would move as well. That's too bad that health insurance won't cover expenses that are necessary.

LoudMan wrote on July 24, 2014, 11:23 AM

United Healthcare sounds awful. I'm of the mind that insurance is a sucker's bet.