Contact 2: Family fights insurance company over daughter’s rehab denial

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FENTON, Mo. – If you’ve felt the warmth of a baby’s smile or been charmed by the twinkle in their eyes, pray you never live the terror of fearing your child could die.

“Watching the EMTs come in and just whisk her and start working on her. It was just…I can’t even put it into words how difficult that was,” said Kaeci Bell of Fenton.

Bell’s fear intensified because doctors were mystified by baby Louella’s illness.

“We had no clue what her condition was, we just knew it was very severe,” she said.

Louella spent a month in the hospital, much of that time in the pediatric intensive care unit. Tests revealed several viruses, brain swelling, and dead tissue. When her condition stabilized, she was transferred to Ranken Jordan Pediatric Bridge Hospital for rehab. After nearly two weeks of progress at Ranken, a setback occurred.

“Ranken thought it was in the best interest that she go back to Cardinal Glennon,” Bell said.

Louella’s second stint at Cardinal Glennon was brief and the Bells assumed she’d resume rehab. That’s when they say they learned their insurance company, Anthem Blue Cross Blue Shield, would not cover Louella’s return to Ranken.

“If she’d been denied from the very beginning, okay, but she was there, she’d been accepted. She’d been approved to be there. And then not even two weeks later to be told she can’t come back by the insurance company… It’s not right. It’s not fair,” Bell said.

The denials came despite doctors’ recommendations.

“Rankin did three appeals, a peer-to-peer conference with Anthem, and they just kept denying us all the way through,” Bell said.

Fearing Louella’s development was on the brink, the Bells hope Anthem will cut through the red tape so they can focus on cutting birthday cake.

“We’re getting ready to plan her first birthday and is she going to be able to sit in a highchair? Is she going to be able to enjoy that cake like she’s supposed to? Right? Those are the things that I think about. I want to get her back to where she’s supposed to be,” Bell said.

Fox 2 and News 11 questioned Anthem about its decision. In a statement, a representative said, “Anthem Blue Cross and Blue Shield is committed to providing access to medical services and treatments that have been demonstrated by medical evidence to be effective. This case was reviewed against clinical guidelines that are in place for the type of treatment requested. Based on the medical information we received and clinical guidelines, the requested inpatient rehabilitation stay did not meet the criteria for coverage according to the consumer’s benefit plan. This decision does not prevent or advise against utilizing safe, effective, evidence-based outpatient rehabilitation treatment options that are readily available and covered under Anthem benefit plans.”

Bell’s attorney says he’s planning to file suit in the coming days. We’ll keep you posted on what happens.

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