SpedPro

Insurance policies

By John Lloyd on Dec. 30, 2007.

This is not really a an educational story, but one that reveals another gap in the care received by individuals with disabilities. It’s the story of the Denney family and a child, David, who has such substantial disabilities that he requires extensive nursing care. Perhaps most surprisingly, it is the story of an insurance company that, after agreeing to pay for the care for years, reverses itself and forces the family to fall back on public sources for the care.

Using reasonable procedures (e.g., letters from David’s physicians), the Denneys sought to persuade the insurance company that David needed the services; when denied, they decided that the insurer’s reversal was not appropriate, and they sued.

Lisa Girion, of the Los Angeles Times, reports the story of David Denny and the Denney’s suit against the insurer. Here’s her lead:

At 13, David Denney’s body functions like that of a baby. Severe brain damage halted his motor development at 4 months.

Unable to walk, sit up, speak or even eat by mouth, David is cared for by a licensed vocational nurse who feeds him formula through a stomach tube, watching closely in case he retches.

Blue Cross of California, the family’s health plan, paid for the nurse for most of David’s life at a cost of about $1,200 a week.Then about two years ago, the company decided that David didn’t need a nurse anymore — contradicting the opinions of two of David’s physicians — and it stopped paying.

Link to the article.

Sphere: Related Content