Dear Cigna,
I am writing to you as a concerned parent whose 4-month-old son, Elijah, requires Elecare formula for his survival due to a severe cow’s milk protein allergy. This isn’t a choice we made lightly; it is a necessity for his health and well-being.
Elijah was born prematurely at 37 weeks due to my pregnancy complications, specifically preeclampsia, and he was medically induced. Before we dive into the often-debated topic of breastfeeding, let me clarify: he was unable to latch properly, diagnosed with a weak suck and bilateral buccal ties. Feedings were a source of immense stress, and despite having two older children, I was determined to provide him with breast milk, leading me to exclusively pump.
Unfortunately, even my breast milk, which is often touted as the ideal nutrition, caused Elijah significant discomfort. During his first four weeks, he was in constant distress, with symptoms including loose, bloody stools and relentless screaming. The thought of breastfeeding was simply not an option for us.
After weeks of trials and consultations, we were referred to a gastroenterologist who confirmed our fears: Elijah has a severe case of cow’s milk protein allergy (CMPA). While some children may only experience mild symptoms that can be managed with formulas like Nutramigen or Alimentum, Elijah exhibits severe reactions including diarrhea, eczema, reflux, and more. He cannot tolerate even a trace of cow’s milk protein, whether it’s whole or broken down.
Following our doctor’s advice, we switched to Elecare and started administering Levsin drops for his acid reflux. The agony of watching a baby struggle with reflux is unimaginable, as any parent can attest. But our next step? Contacting our insurance provider.
Here’s the kicker: one small 14.1 oz can of Elecare costs $45 and lasts about 2-3 days. As he grows, his consumption will only increase, potentially costing us over $450 per month. In contrast, a can of Enfamil, which is a standard formula, retails for about $12-14.
When I reached out to Cigna, I was informed that numerous medical-grade foods and formulas are covered under our plan—except for Elecare. This leaves me bewildered. I am expected to cover the cost of this essential formula without assistance while other products, such as Glucerna, are readily available to me.
Our gastroenterologist was incredibly supportive, providing samples and fighting on our behalf. We meticulously completed every form required, including prescriptions for caloric intake and a letter of medical necessity. We submitted Elijah’s entire medical history to Cigna and waited for a decision.
The response we received was disheartening: denial. Cigna stated that Elecare is covered only for specific diagnoses, such as inborn errors of metabolism. CMPA does not make the cut. This was infuriating. My son requires this formula to thrive, and yet your policies deny him the necessary support because his diagnosis doesn’t fit neatly into your criteria.
In Texas, it is mandated that insurance companies cover baby formula, particularly when it is medically necessary. With the significant contributions my husband makes through his employer, combined with our monthly premiums, it seems reasonable to expect coverage for this essential medical food that Elijah needs to survive his first year.
I can’t help but wonder, if Elijah were hospitalized due to failure to thrive or dehydration, would you hesitate to cover those exorbitant costs? It seems more cost-effective to support his health proactively instead of waiting for a crisis.
I reside in a small town where I know many parents grappling with similar challenges. It’s high time for legislative changes to ensure that families receive the support they need from insurance providers. I urge our lawmakers to advocate for policies that align with our needs, not against them.
Sincerely,
A Concerned Parent of a Child with Food Allergies