Dear Cigna,
My name is Emma Thompson, and I am writing to you as the parent of my precious 4-month-old son, Leo, who is reliant on Elecare for his nutrition. This isn’t just a choice for us—it’s a necessity for his survival due to his severe cow’s milk protein allergy.
Leo was born prematurely due to my pregnancy complications, specifically preeclampsia, which required a medical induction. Before we delve into the topic of breastfeeding, allow me to clarify: Leo was unable to latch. His situation was described as a “poor latch” with a weak suck, compounded by bilateral buccal ties. Feeding him was a monumental challenge, even with a bottle, leading me to exclusively pump milk in the hopes of providing him the best nutrition.
However, despite my efforts, my breast milk—which is often hailed as the ideal source of nutrition—caused him immense discomfort. For the first month of his life, he cried incessantly, suffering from severe stomach pain. His diapers were filled with blood and mucus, and each bowel movement seemed agonizing. Breastfeeding was simply not an option for us.
After weeks of trials and consultations, we were referred to a gastroenterologist who confirmed our fears: Leo was diagnosed with a severe case of cow’s milk protein allergy (CMPA). CMPA can manifest in various ways, from mild digestive discomfort to more severe symptoms like the ones Leo experienced—constant pain, diarrhea, eczema, and reflux. Even the most broken-down formulas available did not agree with him.
Following our GI’s recommendation, we began using Elecare, alongside prescribed antispasmodic drops. This formula has been a lifeline, but soon after we discovered its monthly cost: $45 for a mere 14.1 oz can, which lasts only 2-3 days at his current feeding rate. As he grows, this quantity will only increase, leading us to an impending monthly expense of over $450. For comparison, a standard can of Enfamil costs around $12-14 and is available in bulk at a reduced price.
Imagine my surprise when I contacted Cigna to inquire about coverage for Elecare, only to be informed that it is not included under my plan. While various other medical-grade formulas were listed as covered, Elecare was notably absent. This left me dumbfounded—are we really expected to bear this financial burden alone? If Leo required Glucerna, I know it would be delivered to my doorstep without hesitation.
Our gastroenterologist worked tirelessly to advocate for us, providing samples, coupons, and extensive documentation, including prescriptions and letters of medical necessity. We meticulously completed every form Cigna requested. Yet, we were met with a resounding rejection. Why? Because Elecare is only covered for specific diagnoses, specifically those related to inborn errors of metabolism. Unfortunately, CMPA does not fit into that narrow definition.
It is infuriating that we are being denied coverage for a formula that is critical to my son’s growth and health simply because it doesn’t align with your criteria. The consequences of not having access to Elecare could result in failure to thrive or severe dehydration—outcomes that no parent should have to contemplate. This isn’t a comparison of illnesses; it’s about the care that all children deserve, regardless of their specific conditions.
In Texas, it is mandated that health insurance plans provide coverage for baby formula. Considering that my husband and I contribute over $1,200 a month towards our plan, it’s only reasonable to expect coverage for a medical necessity like Elecare.
I can’t help but wonder—if Leo were hospitalized due to failure to thrive, would you challenge the costs of his care? It’s disheartening to think that you would rather pay for the aftermath than contribute to his health and well-being now.
In my community, I know countless families facing similar battles with their insurance companies over necessary formulas. To our lawmakers, I urge you to amend the law to ensure all health insurance providers support families in need, rather than putting obstacles in their way.
Sincerely,
A concerned parent of a child with food allergies
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