Buffy's Battle

Buffy Smith: Insurance Policy Slayer

Buffy Smith found herself, her family, and her baby daughter, Bailey, in a classic insurance company “Catch 22”. When Bailey was just five months old in December 2005, she stopped eating. Every doctor visit, test and hospitalization could not diagnose what remains a gastro-intestinal “mystery” disorder. And, Bailey was literally starving herself.

Buffy and her husband, Ty, began feeding her through external pumps to keep her alive. But, the life-saving feeding pump was not covered by Ty’s employer’s insurance policy. The coverage offered through the State of Colorado where Ty works as a district wildlife manager would only kick in if Bailey was suffering from a metabolic disorder. In addition to the pump, the costs of all the supplies and tubes were excluded from the policy. As a result, Ty and Buffy needed to find $2000 a month to pay for this medically necessary equipment as well as try to pay for the doctors, hospitals and tests. The irony of the situation was that the insurance plan would pay for much more expensive IV feeds which require a professional nurse to administer and come with a higher risk of infection to the patient than the external pump.

Buffy and Ty tried everything they could think to secure some coverage to avoid financial ruin for their family, which in addition to Bailey includes Morgan, their 2 ½ year old son. They tried the appeals process and applying for Medicaid. It was in every way a nightmare. “We got the complete runaround from the State of Colorado human resources to the insurance company. We also were turned down by Medicaid because we made $100 too much per month” recalls Buffy.

Because the State’s plan was considered “self-funded” by the insurance company, it was up to the State to make exceptions to the policy. Yet, the State personnel continually referred back to the insurer’s restrictions. “Plus, because this was technically the State’s plan versus a traditional company plan, there was not a government agency, like the Division of Insurance, that could help us.”

After the tears, the appeals, the paperwork and the frustration, Buffy got mad. She began contacting the local media about her family’s story. The media attention as well as the persistency of one local reporter --- who called everyone from Ty’s boss to the Human Resources division to other State of Colorado officials --- really made things happen. Over the course of the year, through Buffy’s and Ty’s efforts, the State revised the plan for the fiscal year starting July 2006 which will now cover the external feeding tubes. “Of course, we are very happy to have this covered for our baby, but we are so excited that many other employees and family members covered by the plan will now have this benefit,” says Buffy.

Buffy continues her search for the cause of Bailey’s disorder as she and Ty get ready to meet a new team of specialists in Wisconsin. “It will be a life long battle, but we’re ready.”

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