insurance company denies wheelchair for boy with cerebral palsy

Any parent could tell you that raising children is a challenging and rewarding endeavor. Parents who have newborns or toddlers quickly learn that the majority of their time will be spent caring for their children and helping them grow and develop. When parents have children who are born with birth injuries, such as cerebral palsy, they often spend more time — and money — helping their children develop.

Because cerebral palsy compromises the body’s ability to control movement and posture, parents often provide more assistance helping their children get around. When many babies are crawling through houses, children with cerebral palsy may still need to be carried everywhere.

In one family, a 2-year-old boy’s cerebral palsy made it impossible for him to walk or sit up without assistance. Regardless, until the parents teamed up with a Pennsylvania TV station, the insurance company refused to pay for the boy’s wheelchair.

The toddler’s parents spent more than two years carrying him everywhere. When he grew heavier than 30 pounds, the doctor prescribed a specialized wheelchair. The wheelchair could help the boy become more independent, and it would alleviate some of the physical stress his parents endured by constantly carrying him.

However, when the parents contacted Anthem Blue Cross Blue Shield, they were told the boy needed to try walking with a cane before the insurance company paid for the $5,000 wheelchair. The boy’s cerebral palsy made it impossible for him to even sit up without assistance. How could Anthem expect him to walk with a cane?

According to Anthem, the wheelchair was not medically necessary — even though it was prescribed by the boy’s doctor.

The parents tried repeatedly to explain that the wheelchair was a necessity, but when the insurance company wouldn’t budge, the parents went to a local Pennsylvania television station. A reporter called the insurance company the next day, and the boy’s wheelchair was approved the following day. Although Anthem Blue Cross Blue Shield insists the timing was a coincidence, it seems unlikely.

Thankfully, the family was able to receive the medical equipment they needed — but it did not come without an extensive fight. This family turned to the news station, but it’s important to remember that there are numerous avenues to pursue if you do not receive the insurance coverage you know you deserve. Parents who have children with birth injuries face enough struggles with their care; they should not be victimized again by their insurance companies.

Source: The Consumerist, “Anthem BCBS Decides Boy Who Can’t Sit Up On His Own Doesn’t Need a Wheelchair,” Chris Morran, June 13, 2012

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