Pic credit: Joushua Lowry/ GoFundMe
A North Carolina family is preparing to take their 12-year-old son to Boston for a heart procedure despite an insurance denial that arrived just days before their scheduled trip to the hospital on October 19, ABC 13 reported. Rowan Lowry was 7 when doctors diagnosed him with Kawasaki disease (KD). Mostly seen in children younger than 5, KD affects boys more often than girls. In the US, the disease affects about 9 to 20 per 100,000 children under the age of 5, according to the agency. Rowan is scheduled to undergo a stent procedure on Monday, October 19, at Boston Children’s Hospital.
The insurer reportedly called the procedure “medically unnecessary and experimental”. The boy, who has already undergone open-heart surgery, requires the stent before his arteries narrow further, the family said. It is a disease that can cause damage to the heart and blood vessels, according to the Centers for Disease Control and Prevention (CDC). Cheryl Presnall, the insurer said the procedure was “deemed medically unnecessary and experimental”, according to his mother. Miranda Yaver, an assistant professor at the University of Pittsburgh who studies insurance denials, says patients whose illnesses do not fit the textbook presentation of a condition often struggle to get care approved. “Things that maybe are lifesaving are ultimately getting denied because it’s not a textbook presentation of the condition,” Yaver said.
Its cause is unknown.
They did not have time to appeal before the trip and plan to fly out anyway. Days before the trip, the family’s insurer sent a denial letter.
The 12-year-old has already undergone open-heart surgery.
The family says the diagnosis came late. By the time doctors treated the disease, Rowan had developed multiple aortic aneurysms, which are weak, bulging spots in the body’s main artery. “This has become a lifelong battle for him, and for our family it is heartbreaking and frightening. Without this procedure, Rowan’s condition would worsen. If the artery becomes too narrow for a stent, doctors may have to perform another open-heart surgery, his mother added. They are going anyway.
We are all scared,” his father previously wrote on a GoFundMe page set up to raise funds for his treatment. The family did not have time to appeal before the procedure date.