October 3, 2009

(h/t Heather at VideoCafe)

Amy Goodman interviews Stacie Ritter, whose twin daughters are being denied coverage by CIGNA for the followup care they need from the side-effects of cancer treatment:

STACIE RITTER: Hi. Thank you, Amy. Thanks for having me.

AMY GOODMAN: Hi, Stacie. Tell us your story.

STACIE RITTER: Well, it’s a rather long one, so I’ll try to make it as brief as I can.

Our issues with insurance companies have been going on now for quite a while. It didn’t start with CIGNA, though, until April Fool’s Day of 2008. That’s when my husband’s employer switched insurers to CIGNA, which, again, as far as healthcare is concerned, you don’t have a choice. When your employer switches insurers, you get what they give you. And unfortunately, we were given CIGNA.

My girls are cancer survivors. They had pituitary and hypothalamus gland damage as a result of chemo and total body radiation to treat their cancer as part of the stem cell transplant that they had when they were four years old. And a lot of times when a child has that issue, they end up on growth hormone. Many years later, once the oncologist notices a—like a plateau in their growth, which mine did back in 2005, so she referred us to an endocrinologist at Children’s Hospital in Philadelphia, and he monitored them. And they didn’t start growth hormone until 2007. So that was two years of monitoring to make sure, you know, that it wasn’t just a little lax in their growth and that it was really a damaged pituitary and hypothalamus.

And once they started the growth hormone under our previous insurer, which was Aetna, they did very, very well. And so, our doctors said, well, then, that’s—their positive response to the medication is proof that it was damaged, then, the hypothalamus and the pituitary gland. So that was great, so we’ll continue to do this until their bones start to fuse and they no longer need growth hormone.

But unfortunately, CIGNA does not feel the same way that our previous insurer and our world-renowned expert doctor felt. So they claim to have had two endocrinologists look at our case, and both of their endocrinologists deemed that my girls just suffer from idiopathic short stature, which means short stature of unknown origin. But quite to the contrary, we know the origin. We have lots of documentation and proof of the origin.

AMY GOODMAN: And that was—you say that was the radiation that they were exposed to to deal with their rare cancer.

STACIE RITTER: Yes. And chemotherapies, too, are very toxic, and also depends on the child’s age at the time, and even the sex has a lot to do with it. So, the younger the child, especially under five, which mine were—they were four at the time—and the sex—females tend to suffer more damage than males for some reason from the total body radiation. Not all children with cancer have these kind of late-term effects. It’s only children who have had radiation to the brain area, which mine did.

JUAN GONZALEZ: Well, and once CIGNA denied you, how long did the appeals process go on for you to try to get them to reverse the decision? And what was happening in between the time that they denied you? Did they immediately—were your daughters then not able to get the drug?

STACIE RITTER: Well, we were very fortunate to be treated at Children’s Hospital. The doctors there know how the insurance companies work. So when I told them ahead of time that my husband’s employer was switching insurers, they immediately enrolled us in a program sponsored by the drug company that makes the growth hormone that we’re using. And that program is like a bridge program, where they will supply and even have representatives represent me in the appeals process. So, no, we didn’t have to go without it, thankfully, because my doctors were proactive and knew that the insurance company was going to go through this and deny it and give us the runaround.

Once—it was about three months of dealing with CIGNA. My doctors called them and did a peer-to-peer, because they were not approving it. The written information and the medical documents were not enough for CIGNA, so they had a peer-to-peer review scheduled. And CIGNA even went as far as approving the medication for my one daughter on that peer-to-peer review with our endocrinologist and claiming that it had no knowledge of my other daughter existing. They had the knowledge that she existed when they sent me the denials for her.

AMY GOODMAN: They’re identical twins.

STACIE RITTER: Yes, mm-hmm.

AMY GOODMAN: Well, we invited CIGNA to join us on the program, but the company declined our request. The spokesperson, Chris Curran, issued the following statement, quote, “There was no laboratory evidence of growth hormone deficiency. Over a year ago, we had two endocrinologists review this case and based on the laboratory studies, they agreed there is no need for the drug. This is the first time we are hearing about the family’s concerns and disagreement with the decision. We would welcome review of new information as technology and medical evidence is in constant evolution." Your response, Stacie Ritter?

STACIE RITTER: That’s a joke. Actually, I just received—every year we have to re-enroll in this program. And my doctor had to resubmit a request for coverage to CIGNA again this year. And we just received this year’s denial letters from CIGNA on the situation and then had to re-enroll again with the manufacturer. And that’s carrying us through then. So they are very aware of this situation. They have been.

Unfortunately, our primary endocrinologist who was handling our case had passed away himself of pancreatic cancer last year. And in the scurry to try to cover all of his patients, you know, all of the doctors there in the endocrinology department have had to divide them up. So I’ve had at least four different endocrinologists from CHOP working on my case alone, from writing letters to the peer-to-peer, to the correspondence from the manufacturer, to me calling them. They’re very aware of the situation.

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