My daughter has really severe scoliosis. My health insurance will pay over a $100,000 for major surgery, but will not cover an alternative treatment that works. Do you have any suggestions on how to pay for medical treatment that health insurance will not cover?
Dad In A Bind
Dear Dad In A Bind,
I assume that you have already gone through the appeal process with your health plan. The appeal process gives you a chance to put forward your side of the story, and get a new person to look at the information. So, don’t take the plan’s first answer as the final answer.
You should find out if the alternative treatment she is getting is FDA approved for some other condition. If so, she is getting it “off label” — for another purpose than it was intended for. And if so, you might be able to persuade the insurer to pay for it. If not, then you are probably out of luck.
Have you considered applying for Social Security Disability for your daughter? If her scoliosis is severe, she may qualify for Social Security Disability benefits which would then qualify her for Medicaid. Strangely enough, Medicaid often has better coverage and more flexibility than private plans especially for high-needs children. She would not have to give up her private plan coverage, in order to get Medicaid benefits.
However, even Medicaid will not pay for something that is not FDA approved.
If the treatment is provided by a licensed practitioner, then you could get the money reimbursed from a flexible spending account or health savings account. (See IRS publication #502 for more information.) This doesn’t pay for the treatment, since it is your money taken from your paycheck, but at least you would save the taxes on it.