Colton Needs Our Help
Update: As of 5/26/17, United Healthcare has overturned their denial, and Colton’s Omnipod will be covered under the Porter Family’s policy. Thank you to the thousands of people who helped raise awareness for Colton!
Editor’s Note: Read this Dad’s plea to United Healthcare requesting coverage for his autistic, 2-year-old with type 1 diabetes to have the insulin pump he needs (and has been prescribed). Then help by speaking up on behalf of Colton and his family. Let’s make some noise!
I am a Dad to a wonderful 2-year-old boy that was diagnosed with type 1 diabetes four days before his second birthday last year. After several days in the hospital we were able to go home and learn how to care for a toddler with type 1 diabetes. I would be doing him an injustice if I failed to mention that a few months later he was diagnosed with autism. Just when I thought I was obtaining a novice understanding of type 1 management, we began working on speech and communication skills with my son, who is for the most part nonverbal.
Colton’s endocrinologist and developmental pediatrician recommended, and we were able to obtain, the Omnipod Insulin Pump. Having a pump is critical because, as parents, monitoring a non-verbal child’s blood glucose levels is particularly challenging. Moreover, Colton—an autistic 2-year old—does not tolerate injections well. A separate blessing (I use this term loosely) of his autism is that he will not tolerate loose clothing, strings, blankets, jackets, or any other lose hanging things that touch him. And that common reality of autism makes Omnipod, a tubeless insulin pump, a critical part of Colton’s care. We have already paid for the pump and have been successful in treating with Omnipod. Colton is doing well. And now United Healthcare is putting his health at risk.
The Omnipod, specifically, was prescribed. We were initially told that the pump would be covered under our plan. And then United Healthcare reversed course and told us that they would not cover the pump. So we obtained a peer-to-peer review, per United Healthcare’s request, with his endocrinologist and a medical director from UHC.
The medical director concluded, despite the opinions of his endocrinologist, pediatric specialist, PCP and parents, that the Omnipod in this case would not be cost effective, and therefore would not be covered. The opinion was a financial one, not one based on the necessary care my son needs.
The UHC solution requires us to pay another $15,000 deductible for a cheaper alternative (with a tube) that we know Colton will be unable to use. He will pull that tube out in less than 60 seconds and/or break/disconnect/drop the personal diabetes manager (PDM) because it won’t fit in his pockets … he’s 2. And then we’ll be back to square one.
We already purchased the pump. We need United Healthcare to see past the money and understand a customer’s health needs. We need United Healthcare to cover their portion of what he has been prescribed as a medical necessity. We need United Healthcare to care for its type 1 diabetes (T1D) customers. We’ve appealed, yet again, for Colton to get what he has been prescribed. United Healthcare promised us an update on May 19th, 2017. Today is May 23rd, 2017*. How many days will they keep Colton waiting?
*on May 24th, 2017, Colton’s family received word that the denial was upheld. They are currently looking into re-appeal procedures to continue this fight for Colton. They need our collective voices now more than ever.
Update: As of 5/26/17, United Healthcare has overturned their denial, and Colton’s Omnipod will be covered under the Porter Family’s policy. Thank you to the thousands of people who helped raise awareness for Colton!
COLTON NEEDS OUR HELP – here’s what you can do:
Tell UHC that Colton needs an Omnipod, and that UHC needs to provide adequate care to patients with type 1 diabetes. Tell them our lives are not for profit. Here are a few ways:
- Shout it on social media! Tag @MyUHC (Twitter) or @unitedhealthcare (Instagram and Facebook). Use #CoverColton. For samples, check out our Facebook, Instagram, and Twitter posts.
- E-mail UHC CEO Stephen Hemsley and/or Senior VP Rober Oberrender directly at stephen_j_hemsley@uhc.com and Robert_W_Oberrender@UHC.com
- Call 952-936-1300 to be connected to a United Health Group Representative.
See what our CEO Sarah Lucas wrote to UHC HERE and feel free to use as a sample for your own letter!
The family is also using these hashtags: #UHCFail #UnitedHealthCareFail #IWillNotGoQuietly
You can learn more about the Beyond Type 1 Access Fund HERE.
