|
Without a nutritional formula administered through a feeding tube in her stomach, Ashley Zundel will likely die. But the Zundel family's supply of formula is diminishing, and their health-insurance provider refuses to pay for the expensive treatment.
In an attempt to force Blue Cross Blue Shield to pay for the treatment, the Zundels, of Orem, are suing the company in U.S. District Court. Ashley's parents say the company's policy covers their 9-year-old daughter's medical condition, but the company has refused to pay for any of the formulas that serve as her only source of nutrition. Representatives of Blue Cross Blue Shield's corporate communications department could not be reached for comment on Thursday. In December 2006, Ashley was diagnosed with eosinophilic gastroenteritis, a disease that causes high white-blood-cell counts that wreak havoc on the digestive system. After being diagnosed with the disease, Ashley could only eat five foods, including rice, rice milk and sugar, because they were the only foods that did not make her sick. But Tammy Zundel, Ashley's mother, says the condition has worsened over the past six to 12 months, and Ashley must now be fed through a feeding tube in her stomach. "Without it she has nothing. She's allergic to everything that we've fed her, so this is it. It's her sole source of nutrition," Tammy said. The Zundels are suing to force the R.H. Donnelly Group Health Plan, which is administered by Blue Cross Blue Shield of North Carolina, to pay for EleCare, the nutritional formula that costs nearly $1,000 a month. Brian King, the family's attorney, said the company won't pay because it classifies EleCare as a nutritional supplement, which is not covered by its plan. Tammy points out that EleCare and other similar formulas are not available over the counter, can only be obtained on a doctor's orders and must be used under a doctor's supervision. "It's not like they're out and buying Ensure for their daughter because she's five pounds underweight and they want to be reimbursed for the $10 that it cost them at Costco," King said. "This is a prescription medication. It's extraordinarily expensive, and it certainly falls within the scope of coverage of their health-insurance plan." Tammy said Ashley's doctors at Primary Children's Medical Center in Salt Lake City are dumbfounded by Blue Cross Blue Shield's refusal to pay for the formula. The facility has other patients with conditions similar to Ashley's, she said, and most of those patients' insurance companies pay for the formula. With no assistance from their insurance, the Zundels are having trouble providing formula for Ashley. Tammy said Ashley is currently being fed with a donated supply, but that will run out in about a week. A woman in New York whose son was recently taken off formula donated a three-week supply and is sending more formula that may last Ashley for another month or two. "After that I don't know. I just keep scrounging around," Tammy said. Tammy founded the Utah chapter of the American Partnership for Eosinophilic Disorders, a support group for people with conditions like Ashley's. For more information on eosinophilic gastroenteritis, visit the group's Web site at www.apfed.org, or contact Tammy at
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
• Jeremy Duda can be reached at 344-2561 or
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
|
