OKLAHOMA CITY (KFOR) – The Elliot family feels like a weight has been lifted off their shoulders after receiving a letter that their son’s life-saving infusion will be covered by insurance.
In early November, NewsNation local affiliate KFOR reported on Adam Elliot, an 18-year-old battling a neurological disorder that can only be described as your “brain on fire.”
Their insurance company, Blue Cross Blue Shield of Oklahoma, denied coverage of an infusion that is life-saving for Adam, saying it was “experimental.”
However, after an external review with the Oklahoma Insurance Department, the family says Adam will have his medicine covered.
“We’ll start the treatment early in the morning,” said Wendy Elliot, Adam’s mom. “It takes about 8 to 10 hours to make sure that it doesn’t cause any side effects. We’ve been lucky. Adam has had very few side effects.”
The family’s insurance company, Blue Cross Blue Shield of Oklahoma, denied coverage of Adam’s Intravenous Immunoglobulin, or IVIG, infusion. They said the medication was “experimental” despite previous coverage and letters expressing that the treatment is medically necessary.
“It was like there was no movement,” said Wendy.
Wendy says she had no choice but to request an external review with the Oklahoma Insurance Department.
“It was submitted on a Wednesday, and by the end of Friday, they had already reviewed it,” said Wendy.
An external review allows you to have your dispute reviewed by experts who have no connection to your health plan, according to the Oklahoma Insurance Department.
“They were like, okay, there are multiple different reasons we can approve this, and it’s approved now for a couple of years,” said Wendy.
In the review letter, the department found that the family’s policy is supposed to cover the infusion. Forcing the denial to be overturned.
“Every step that we went with the company, they kept on denying it, denying it, denying it, saying, this is not covered by your policy, but it was,” said Wendy.
While Adam is relieved to be able to get the infusion, through all of this, he says he worries about others fighting the same battle of denial.
“I think I knew eventually that they would cover it, especially because they did it before,” said Adam. “I think the thing that is very disturbing is that these insurance companies will be responsible for the deaths and the suffering of a lot of people.”
Wendy says she has had a lot of people reach out to her, sharing their stories of being denied.
While she is happy her son will receive the life-saving medicine, she says the fight is not over, and hopes this does not happen again in the future.
News 4 reached out to the Oklahoma Insurance Department, but we have not heard back yet.
We also reached out to Blue Cross Blue Shield of Oklahoma for a comment regarding the external review, but we have not heard back yet.