Insurance Company Refuses To Provide Food for Child
By Gerri Elder
Will a pre-schooler have to file a personal injury lawsuit against the city of New York just to be able to eat? That is the question her mother is asking after the family's insurance program has refused to pay for the formula that, because of a medical condition, is the only food aside from pears and rice that the child can eat.
Hannah Devane is the three-year-old daughter of a New York City police lieutenant and his wife, a registered nurse. Hannah is not a picky eater, she simply can't eat because she is allergic to food. She has an illness called eosinophilic esophagitis, which is an allergy to almost all food. Eosinophilic esophagitis causes a type of white blood cells called eosinophils to gather in the esophagus and cause inflammation and damage to the walls of the esophagus when food is eaten.
Because of her allergy to food, Hannah can only eat a special formula that her doctor has prescribed, pears and rice. By feeding her the formula, Hannah's parents have stabilized her health and she now weighs 40 pounds. Without the formula, Hannah would need to be fed with a feeding tube so that food would bypass her esophagus.
So, the formula seems like the best solution to keep Hannah healthy. Although she will miss out on enjoying food and the social aspects of eating, her health is protected by this special diet. Now the insurance company says that they will not cover the expense of the formula for Hannah, which costs $1,200 per month, because it is a food item.
The family's health insurance plan is through Hannah's father's job with the New York City police department. Although the formula was prescribed for Hannah by a pediatric gastroenterologist at The Children's Hospital and is her only source of nutrition aside from pears and rice, the insurance company says that they do not cover the costs for food supplements and other over-the-counter items, even if they are medically prescribed.
Without the formula, Hannah would need a feeding tube or she would starve to death. If she were forced to eat a regularly balanced diet, over time her esophagus could actually harden due to scarring and that would make it difficult for her to swallow anything. If the scarring in her esophagus were to become even more severe, she would have to be hospitalized to have her esophagus dilated. If the scarring were to become bad enough, her esophagus could even crack. Hannah simply can not eat food; she must have the special formula.
There is no cure for Hannah's illness. It will have to be managed for the rest of her life, and for now, with the formula it is being managed fairly well. Hannah has undergone food trials to see if there are any foods that she could tolerate, and it was discovered that she can have rice and pears along with her formula. All other foods in the food trials caused damage to her esophagus.
In early November, the last case of formula that the insurance company would pay for ran out. Since that time, Hannah's father, Michael Devane, has been working a second job as a security guard to help pay for her formula. Her mother, Jessie Devane, has picked up three days a week working as a temporary nurse.
The insurance company says that it was an error that the formula for Hannah was ever covered. The administrator of the health insurance program has advised the Devanes to apply for assistance from the company that makes the formula or the Police Relief Fund.
In New York, the state Department of Insurance has no jurisdiction over self-insured plans like the Devanes'. According to the U.S. Labor Department, jurisdiction over health-plan benefits rests with the states and local governments.
So the question remains, will this little girl have to sue the city of New York in order to be able to eat? And if she doesn't, and as a result doesn't get her life-sustaining formula, will her parents have a much more tragic personal injury lawsuit to file? An injury lawyer might be able to help with this case.