Grayson had a normal physical at age one, but months later was rushed to the emergency room and diagnosed with a brain tumor. A pediatric neurologist there told the parents his condition was life-threatening and that he needed to be taken immediately to either Columbia-Presbyterian Medical Center or Yale New Haven hospital.
The tumor was removed, and the trauma is over, but the family spent two years trying to get their insurance company to cover the hundreds of thousands of dollars in hospital bills they racked up. The claims were initially denied because the insurer claimed it was a pre-existing condition. It then said the treatments were outside of their network.
“This is a child who hit his $2 million maximum benefit allowed at age 3,” says Maura Carley, whose Fairfield, Conn.- based firm, Healthcare Navigation, has been fighting the insurer on the family’s behalf. “This is the kind of situation where the family has to have a plan for health-care coverage, because this kid is now uninsurable in the private marketplace.”