CROWLEY (CBSDFW.COM) – A North Texas family is in a very expensive fight with their insurance company over the medical needs of their children.
Right now, Ricky and Sharon Free are paying $1,400 a month out-of-pocket, but the medicine was fully covered just three months ago.
The Free’s have four adopted children. All of them have been diagnosed with Attention Deficit Hyperactivity Disorder, ADHD, and take various prescriptions to control it.
“They’ve been on this medication for years,” said mother Sharon Free, “we’ve had no problem getting this medication in the past.”
In January, Ricky’s employer switched from Blue Cross Blue Shield of Texas to United Healthcare and Ricky said United will only cover 31 pills a month per child, even though the family’s primary care physician, Dr. Mike White, determined two of the kids need much higher doses.
“It’s unfortunate that they have to take that high of a dose,” Dr. White said, “but this big dose works.”
“Their ADHD medicine is key to their day-to-day functionality,” Sharon Free said. “We’re going into debt because we can’t afford the medication, but we can’t afford to take our children off the medication.”
“It definitely will impact what we will be able to accomplish as a family this year if it isn’t rectified,” Ricky added.
The family’s case is far from isolated. Dr. White said other patients are having similar complaints.
“Their insurance plan has a pill limit per month. It doesn’t matter what dosage the child is on or how many months or years they’ve taken it, all of a sudden they’re limited on the number of pills that they can have,” he said, “It’s going to happen more and more.”
Kim Whitaker, a spokesperson for United Healthcare, said the company is looking into the Free’s case, and emailed a company statement Friday afternoon:
“Based on our initial review of the Free’s appeal, the prescription dosage is double the maximum recommended by the FDA for Shelby and four times the maximum dosage for Ryan. Because these dosages exceed FDA guidelines for these particular medications, additional clinical reviews are necessary. We will continue to work with the family to reach a conclusion.”
“I think it should be illegal or something for some person who is sitting in a building somewhere to deny a child medication when they have no clue why this child needs this type of medication,” Sharon said. “It’s infuriating.”
The Free’s worry if United leaves them hanging, their kids will be the ones who lose the most.
State Representative Bill Zedler of Arlington and the Texas Department of Insurance are both looking into the family’s situation.