Wednesday, March 17, 2004

Mom fights for coverage

By John Kiesewetter
The Cincinnati Enquirer

Jennifer Slayton readies her daughter Alyse, 23 months, for one of her breathing treatments. Anthem dropped Slayton's coverage for skilled home care.
The Cincinnati Enquirer/MICHAEL SNYDER

SPRINGDALE - Jennifer Slayton cradles her 23-month-old daughter between her legs on the living room floor as she hooks up Alyse's feeding tube, then her gastric relief tube.

"She's connected to these 24 hours a day," says Slayton, 27, before giving Alyse one of four daily breathing treatments at her parents' home. "You can see she requires full-time care."

But her insurance company, Anthem, doesn't agree.

Slayton, a single mom, is a Butler County sheriff's sergeant and County Jail night supervisor, has taken vacation this week to provide around-the-clock care for her daughter because the county's new insurance carrier won't pay for in-home skilled nursing care covered by the county's two previous insurance companies.

County commissioners are unhappy with Anthem, which had submitted a "considerably lower" bid than competitors to insure county employees starting Jan. 1.

"This child was part of our patient load when Anthem took our business, and now they want to go back on that," said Commissioner Michael A. Fox.

Commission President Chuck Furmon accused Anthem of "cherry picking" cases, and dropping coverage for employees with expensive medical needs.

Anthem spokesman Joe Bobbey said only that the company "abides by the health benefits policy purchased by Butler County."

Slayton says she never had a problem with the county's Humana and Cigna insurance plans. Those companies provided 10 hours of skilled nursing care daily for Alyse, who has epileptic seizures, brain defects and myriad severe medical problems.

"Her previous insurance coverage felt that her condition justified this (skilled home) care... and she is clinically unchanged," said Dr. Ron S. Levin, from the Center for Infants and Children with Special Needs at Children's Hospital Medical Center, in a letter last week.

Slayton says she was assured by Anthem representatives that her daughter's coverage would not change. But in January, an Anthem employee suggested she train someone to care for the feeding tubes.

Home-care coverage was dropped last week.

Slayton has taken time off while commissioners help her apply for Medicaid. If she's not eligible, she says, she will resign from the sheriff's office.

"The only choice this leaves her is to quit her job," Fox said. "I think that's a terrible choice to present a parent."


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