Mom fights for formula coverage for daughter

Mom fights for formula coverage for daughter

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OMAHA, Neb. (WOWT) -- She has a 5-month old, but you won't find a baby bottle in Kim Fisk's fridge. Fisk's beautiful little girl can't survive and grow without special formula that's very expensive. Unable to tolerate any dairy products to gain weight, Harper Fisk can only be fed through a pump and tube.

"It goes in through her nose and goes down into her stomach,” said Kim.

But it’s what she must eat that is milking her mom emotionally and financially. Since it’s life-sustaining nourishment, Kim expected insurance would automatically cover the cost, but she was wrong.

"We are constantly worried about medical expenses and how are we going to afford her formula,” Kim said.

The formula costs from $30 to $50 a can that lasts about two days. Medical experts have told Kim that Harper will have to be on this special formula for a minimum of a year. That means about $6,000 or more out of her pocket.

A registered nurse at Nebraska Medicine, Kim says she was surprised when told her policy doesn't have the option for formula coverage.

"I guess I get a little frustrated with it because the formula is actually treating her medical condition,” Kim said.

Pediatrician Dr. Monique Macklem has seen other infant patients who need the formula to survive, but the parent's insurance wouldn't pay for it.

"A child who needs drip feeds and needs specialized formula, I believe should be covered by their health insurance. It’s not just feeding, it's quality care for their life,” said Dr. Macklem.

Nebraska Medicine states that specialty formulas are often covered when accompanied with documentation of medical need. The Benefits Department is ready and able to help Kim in that process. When it’s filed, her appeal will be promptly reviewed by a board which includes two doctors. Kim doesn't understand why she should have to gather documentation and appeal a coverage, she claims, should be included in health insurance policies.

“There's no difference between a prescription, a medication than this formula,” Kim said.

Though feeding Harper isn't easy or cheap Kim sees strength that will help her daughter grow even though the family bank account is shrinking because of formula costs. Kim says all the appeal paperwork has been filed so she’s just waiting on an answer. She's been told that could take from three to seven weeks.

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