West Seneca, NY (WKBW) – Sophia Watson, a 22-month-old girl, urgently needs life-saving treatment for a tumor, but her family is uninsured due to insurance disputes.
Sophia, who has neurofibromatosis type 1, has a tumor in the optic nerve and requires treatment with oral chemotherapy drugs called mekinists.
“It's inoperable. They told me that if they manipulate it, there's almost a 100% chance that she's going to be blind due to the placement of the ocular nerve,” Benjamin Watson said.
Her parents, Benjamin and Amanda Watson, face a significant financial burden after insurance providers Anthem Blue Cross and Blue Shield refused to cover their medication.
“We're doing everything we can. Are we doing everything in the best possible way, or I think it's the best way possible, but that's difficult. It's very hard. My dad I said.
Sofia's treatment plan involves taking a mekinist once a day for two years, stabilizing the tumor. However, due to insurance denial, a family of five will have to pay $1,800 per bottle and will need two bottles per month. Her dosage increases, and the other she gets.
The denial came after Benjamin Watson changed jobs, resulting in a switch in insurance providers. Since then, Anthem Blue Cross and Blue Shield have not provided coverage for the drug, along with ExpressScript.
When I contacted Anthem BCBS, the Director of Public Relations said Express Scripts, the prescription manager in which it works, is responsible for the denial.
The insurance company has issued the following statement:
“Anthem provides medical benefits through a member's employer, but in this case the employer chose to use the Express script as the pharmacy benefits manager. We are the member's pharmacy benefits manager. They are not affiliated with and have no decision-making authority on this issue. Anthem Blue Cross and Blue Shield are working to ensure that members receive integrated, connected care, and for more information about the medication in question, please see the Members. Helped to connect to the correct pharmacy benefits manager.”
Anthem Blue Cross and Blue Shield
I also reached out to express the script for clarity. A customer service representative said the company has no longer had a media unit, but the Express script stated that the insurer refused to cover the coverage, following coverage standards set by the insurer.
Sofia's parents said the Roswell Park Comprehensive Cancer Center submitted a peer-to-peer review using rapid appeal and express scripts. I contacted Roswell Park for confirmation and waited for a response.
Sofia's family navigates insurance challenges, but they gofundme It helps to cover the cost of the medicine.
