After several insurance appeals, toddler gets potentially life-saving glucose monitor
(KUTV) When you think about diabetes, 1-year-old Brecklyn Stansfield’s adorable face probably isn't what comes to mind. But Brecklyn was born with the disease, as her parents, Shelese and Justin Stansfield, discovered when she was a few months old and suffered a near-fatal diabetic attack.
"We went down in an ambulance,” Shelese Stansfield said. “She was pretty non-responsive and had an I.V. in her head because she was so dehydrated that they could only find a vein in her head."
Now, knowing what to watch for, Shelese and Justin are on constant guard to make sure it doesn't happen again. That means checking her blood sugar levels every few hours, all day and all night.
Brecklyn's doctor says there is a better way in a relatively new technology that can monitor little Brecklyn constantly and then alert her folks when there is a problem. The trouble is their health insurance won't pay.
"They're like, ‘Well, it's not been FDA approved," Justin Stansfield said.
In fact, the monitor has been approved by the FDA, but only for kids older than two-years-old. The agency hasn't said younger kids shouldn't have it, there are just so few infants with diabetes it hasn't gotten the official stamp of approval, Justin Stansfield said.
So Shelese and Justin appealed the denial and even got Brecklyn's doctor on the phone with the insurance company's doctor for what's called a peer-to-peer review.
“[Brecklyn’s doctor] said this was the shortest peer-to-peer she'd ever had,” Justin Stansfield said. “It lasted a total of eight minutes and we have been repeatedly told by the appeals department, ‘You're just not going to get it.’"
Shelese and Justin's insurance company is Select Health. As has become a pattern, the company’s spokesperson refused and an on camera interview and also offered no on-the-record details to our questions. Spokesperson Jamee Wright writes, "We have no comment."
A few days after Get Gephardt’s calls to the insurance company, Shelese and Justin got a letter from Select Health stating, "After further consideration of your request...it has been determined that your request will be granted."
Just like that, Brecklyn got a toddler glucose monitor allowing all of them to sleep through the night and have less stressful days.
Wright stated that the decision to pay for the glucose monitor was made through the appeals process and not due to calls from Get Gephardt.
“I think it's kind of ironic that we had you guys contact them Wednesday and we had an approval letter on Friday,” Shelese said.
The appeals process took several months.