Troubleshooter: Life preserving prescription

February 14, 2011 3:49:53 PM PST
At just 9 months old, Brooke Lechuga was diagnosed with panhypoptituitarism. Doctors discovered she was born without a pituitary gland, so Brooke produces no growth hormone.

Without proper medication, including a daily injection of a growth hormone, Brooke's mom says she wouldn't be able to function properly.

"Death, eventually, it's a slow thing. It won't be next week [if] she doesn't get it, or even maybe in four months. It may be four years or two years down the road. That's still short, and in the meantime your quality of life, you just go downhill," explained Pam Lechuga.

"Through some miracle she has sustained," she continued.

Brooke is able to get the growth hormone she needs through the prescription drug coverage provided by the family's health insurance plan.

"We always felt confident our insurance company was going to be there for us to make sure she stayed healthy. We paid our premiums. We've been with them for over 14 years. They've been good to us, so why the change, why is it so difficult now?" asked Pam.

Lechuga said unexpectedly, her daughter's six-month prescription for growth hormone was denied.

"It's scary knowing that if they cut it out, it's a slow death," said Pam.

Lechuga works as a nurse. She told ABC11 she believes the prescription coverage was denied because of how much the hormone costs.

"It's exorbitantly expensive," she explained. "It's approximately 30 to 40 thousand dollars a year. So each time they deny, that's how much they save," she said.

Lechuga appealed the denial and reached out to ABC11 Troubleshooter Diane Wilson at the same time as she says she believes the growth hormone is vital to Brooke's survival.

"She has a potentially lethal disease," she explained.

ABC11 contacted the Lechuga's insurance company CIGNA. The company looked into it, and Lechuga got a call right away letting her know Brooke's prescription for the growth hormone was approved.

"I was very surprised it happened lickety-split," she said. "Much thanks. I really appreciate it."

Lechuga said Brooke is usually only approved for the growth hormone prescription for 6 months. But after our call, Brooke was approved for the entire year.

CIGNA issued this statement to ABC11:

"We have contacted this customer to work with her to resolve this issue. While we can't provide you with the details because of privacy regulations, the issue is related to the fact that her employer had medical and pharmacy benefits from two different companies. Her request for coverage was not sent to CIGNA, but if it had been, it would have been paid. We are now working with her and her physician to expedite the delivery of her medications and to ensure that the request for the needed medications are correctly sent to CIGNA in the future."

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