Insurer Deems 9-Month-Old's Brain Tumor Treatment Too Expensive

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The child could have died if the hospital hadn't placed him under special care, but according to the insurer, this disqualifies the patient.

Baby stretches its arm.

An insurance company took the word “callous” to a new level by blocking coverage of an experimental treatment being used to save the life of a 9-month-old with an aggressive brain tumor.

What’s worse is that the insurer explained the twisted logic by sending him a letter telling him he was too expensive to keep alive.

Connor Richardson — the baby boy with a rare aggressive teratoid rhabdoid brain tumor — previously had the growth removed. Unfortunately, the cancer returned, prompting St. Jude’s Children’s Hospital in Memphis, Tennessee, to put the child on a combination of different drugs along with an experimental treatment.

The move was deemed necessary to save the boy’s life, but it isn’t the common procedure applied to patients experiencing similar health problems. As a result, the insurance company deemed the lifesaving treatment “not medically necessary.”

“Dear Connor Richardson,” the letter reads. “When we reviewed the information given to us about this request, we have decided to deny coverage of the following medical service(s) or item(s) that you or your provider asked for: Inpatient Hospitalization to St. Jude Hospital from 10/4/2017-10/10/2017. We have determined that the service(s) are not medically necessary.”

"[I]f you decide to have this service you may have to pay it yourself," the insurance company warned.

Explaining that the medications used in his treatment were novel, the insurer, once again, confirmed that the treatment was not going to be covered.

“The principal investigator has requested medications including methotrexate, cisplatin, cyclophosphamide, vincristine in combination with an investigational medication, alisertib,” the company explained in bold letters. “This combination of medications is not the standard of care for this type of cancer, and is considered experimental and investigational at this time, as evidence-based guidelines do not exist to confirm its effectiveness for his brain tumor. Therefore, this request for clinical trial treatment at St. Jude’s hospital is not medically necessary and is denied.”

According to the child’s father, retired NYPD Officer Wayne Richardson, the baby would have died without this treatment.

Fortunately for the 9-month-old, St. Jude’s doesn't charge patients for the treatment. Still, the dad said he thinks the insurer should pay the denied funds since it would help the institution conduct research to help other children.

“You’re taking away from them and their research…because the insurance doesn’t want to pay,” he told reporters.

Rather than helping save the lives of terminally ill children, the insurer will, instead, pocket the money. However, the infant's father is working to file an appeal. 

As St. Jude's continues to treat the baby without charge, it’s clear that only one of these institutions is truly in the business of getting people back to health — and it isn’t the insurance company.

We may see an uptick in these heartbreaking incidents if the GOP has its way with health care reform.

Banner and thumbnail image credit: Reuters/Esam Omran Al-Fetori

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