HAMBURG, N.Y. (WKBW) — Alyssa and Brad Casacci have been fighting for insurance to approve brain surgery for their 11-month-old son, Cameron.
The couple said that hours after Cam was born, he suffered a stroke on the left side of his brain, which progressed to seizures and epilepsy. In the last few months, Cam was hospitalized several times. Then, the couple found out about a drastic brain surgery that disconnects the left side of the brain from the right in hopes of stopping the seizures.
They found a surgeon with experience that they were comfortable with in Pittsburgh and were ready for surgery last month, but it was shut down. Cameron’s insurance is a Medicaid Managed care plan through Independent Health, and the surgery was denied because it was “out of network." The couple appealed, and it was denied. In the denial, Independent Health notified the couple of a surgeon in Rochester, but the couple didn't want someone with less experience to perform the surgery.
But the couple has now received the news that they have been waiting for. Brad confirmed to 7 News that Independent Health has reversed its decision and will allow Cam to have the surgery in Pittsburgh.
According to Brad, the New York State Department of Health sent them a letter urging them to reverse the decision.
Independent Health provided the following statement:
“As a Medicaid managed care plan, we follow federal and state laws, including New York State’s Medicaid rules, which generally do not allow out-of-area or out-of-state coverage of Medicaid health care services unless the service cannot be provided by an in-network provider. When denials occur, Independent Health works with Medicaid members to connect them to in-network providers and facilities capable of delivering the care needed. We adhered to these rules when we issued our decision and directed this member to qualified and highly skilled in-state practitioners capable of providing these health care services.
In this important case, Independent Health has been actively communicating with the New York State Department of Health. The Department acknowledged the general requirement that Medicaid members receive services from in-network providers; however, given the rare nature of the procedure requested in this case, the Department has granted us flexibility to approve the procedure at the facility requested by the member without the need for further appeal or delay.
Federal law (HIPAA), New York State law, and our internal confidentiality policy prohibit us from disclosing additional information related to a member’s protected health information.”
As of now, Cam's surgery is scheduled for August 20.
You can learn more here or watch our previous story below.
