Insurance company refuses to pay for life-saving formula for premature twins
WATCH ABOVE: The Sun Life insurance company has denied coverage for a prescription formula for two sick twins. The family doesn’t know how they will pay for it. Christina Stevens reports.
A Bowmanville, Ont. family is fighting their insurance company to get costly, life-saving formula for their infants covered.
Life has been a struggle for Shaylyn and Grayson Grant since the day they were born – six weeks premature and already suffering from health issues.
Then Shaylyn was diagnosed with an intestinal disease (necrotizing enterocolitis), which was killing off her bowels.
Against all odds, Grayson came down with the same disease.
A few weeks later there was another devastating diagnosis: Shaylyn had Sepsis and the prognosis was poor.
“We’ve almost lost her twice which was very scary,” said the twins’ dad Trevor Grant.
“We were amazed she got through it because she was so small and so sick and then they decided Neocate was the only thing they can do,” said Jamie Barrette, the twins’ mother.
She explained that Neocate, a highly specialized formula, is the infants’ only source of nutrition.
But it costs the family about $2,400 a month, and that number will only increase as the babies grow.
It is too soon to know how long they will require it – that could be anywhere from one to three years – and the family thought they were covered by Grant’s extended medical coverage through work.
“We called the insurance company. They indicated it was covered 100 percent up to 20 thousand dollars per year per child,” said Grant.
However, when they followed up with the insurance company they were rejected.
They couple said they were told that, even though the doctor wrote a prescription for Neocate, because it is formula, as opposed to a drug, it was not covered by their plan.
In a letter to the family, their insurer, Sun Life, admitted staff made a mistake in telling them Neocate was covered.
Sun Life would not answer questions from Global News on the topic, instead referring us to an industry spokesperson.
That spokesperson reiterated that Neocate does not qualify as a a drug.
“It does not have a drug ID number and it is a nutritional supplement and therefore most plans will not cover it and certainly standard plans do not,” said Wendy Hope, VP External Relations, Canadian Life and Health Insurance Association.
“It’s their only source of nutrition. It’s the only option we have and they will not cover it,” said Barrette.
“There’s nothing you can do but sell everything you own and feed your babies,” added Grant, adding that they were still battling Sun Life.
The couple has also started a petition to fight for other parents because they believe the costs should be covered by the government, so no other family has to face what they have had to go through.
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