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When the Life of One’s Child is at Stake

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Timothy McGovern, Nassau County

Timothy started feeling sick after playing soccer with his college team. At first, he thought it was the flu and went to his college infirmary. The next thing he knew is that he was being rushed to a nearby hospital.  He did not know exactly what was wrong, but he knew it was serious.

 

The doctors at the local hospital confirmed his heart was failing and needed more critical care at a better equipped facility. With no time to waste, Timothy was taken by air ambulance to one

of New York’s largest cardiac care centers. The doctors there were able to treat him. Timothy had contracted a virus at school that caused heart failure.  Timothy was discharged from the hospital within days and fully recovered. 

 

Thinking the medical scare was over, Timothy’s parents were later shocked to find out that his insurance was refusing to pay the $60,000 air ambulance bill, saying there was a closer hospital that could have treated him. His parents appealed on their own but lost.

 

Timothy’s mother still gets upset when she remembers the insurance plan’s decision.  “It is unreasonable to think that parents who are told that their son is in a life-threatening situation requiring advanced care will ask, ‘Is this helicopter transport necessary and covered by my insurance?’”

 

They asked CHA for help and were assigned to an attorney with experience appealing denials of emergency care.  He helped write an external appeal arguing that the air ambulance was medically necessary because the local hospital did not have a certain type of equipment. The independent reviewer ruled in Timothy’s favor, resulting in full reimbursement except for a $35 co-pay.

 

"Getting our insurance company to cover services that were authorized by Tim's doctors was the second best moment of the past year; having our son walk out of the hospital with no heart damage, no scarring, no lasting effects, was the best.” Maureen McGovern, Timothy’s mother.