7-year-old boy with congenital heart defect denied lifesaving medical device by insurance company

Medical insurance can save your life by allowing you access to medical care the government cannot supply. Not everyone has the privilege of affording it because it can be quite costly. But, if you can, one expects a certain amount of cooperation. However, the fine print of the policy documents can be very confusing, and they somehow manage to escape paying for certain things. One little boy with a heart problem has been denied insurance and a chance at life. According to them, his condition did not warrant a lifesaving device, even though doctors recommended it.

The little boy denied insurance

In Nashville, Tennessee, a little boy was born with a severe heart problem. The doctors diagnosed Decker Sharp with an atrioventricular septal defect and pulmonary stenosis. His congenital heart defects meant that the pulmonary valve was too narrow, and there were many holes in his heart.

At a mere 8 months old, Decker had a buildup gather in his heart, near to his aorta. This affected the pressure buildup and blood flow in and out of his heart. The result was his first open-heart surgery to release the pressure and stimulate blood flow. Although, the pressure in his thinning aorta is still building up.

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An active child

Decker is not a child who likes to lounge all day on the sofa playing video games or watching cartoons. He is an active child and loves to play sports. He and his family are alike in that regard. For now, Decker has the go-ahead from his pediatric cardiologist, Dr. English Flack. But on one condition. She wants his family to have an automated external defibrillator, or AED available at every one of his sports events, and practices.

Dr. English Flack says the device could save his life because he is at risk of cardiac arrest. If young Decker were to go through that, the doctor feared it might take his life. The cost of an AED can range between $1,000 and $3,000, they are the same machines found in ambulances all over the world. they were unable to buy one as a family. So, they contacted their medical insurance company, Anthem, to see if they would provide one for Decker. However, he was denied insurance.

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A refusal from Anthem Medical Insurance

Anthem, one of America’s biggest insurance companies, took their request into account. However, they denied Decker an AED. They said that Decker’s condition does not need one, according to the medical research and evidence.

According to a statement made to CBS News, an Anthem spokesperson said: “The existing medical evidence does not support that AEDs offer benefit to patients with atrial septal defects, and as a result, these devices are not a covered benefit under the family’s health plan“.

Decker’s family is very “disappointed” by Anthem’s decision. By Decker being denied insurance they are forced into a hard reality. They would need to make Decker quit playing sports, or risk losing him altogether. This story has raised awareness of the fact that even though medical insurance companies are not doctors themselves, they have the power to deny insurance over certain things.

They said “We are disappointed in Anthem’s decision, but unfortunately not surprised. Our hope remains that this will start a conversation to set parameters around when AED coverage is appropriate. They certainly save lives. Moreover, we wholeheartedly believe doctors should lead healthcare decisions, not insurance companies

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