ERIE, Colo. (KDVR) — An Erie family is feeling relieved because their insurance company is now agreeing to cover a high-priced back surgery for their teenage son after the original claim and appeal were denied.
As a young teen, Justin Pisano was diagnosed with a severe case of Crohn’s disease. His body was not absorbing nutrients.
“He was about 13 years old, 75 pounds,” his father, Al Pisano, said.
Pisano said medication for Crohn’s and growth hormone are getting Justin back on track. He is gaining weight and growing,
But at the same time, his scoliosis is becoming more severe. His spine is curved and twisted.
“It’s been really challenging,” Pisano said.
Justin’s doctors at Children’s Hospital Colorado recommended VBT or Vertebral Body Tethering. It’s an FDA-approved procedure that is now used as an alternative to spinal fusion.
“They put tethers on the spine. The child’s own growth actually straightens their spine,” Pisano said.
The family said the base cost of the procedure is about $136,000.
They say Anthem Blue Cross Blue Shield of Colorado, the family’s insurance company, denied the original claim and appeal.
Letters to the family from the company show the procedure was deemed “investigational.”
The family said they spent hours on the phone to fight this. They asked for an external investigation, and they contacted the media.
Then on Wednesday, the family got word that the insurance company will cover the procedure.
A statement from Emily Snooks says, “Anthem Blue Cross and Blue Shield in Colorado is committed to providing access to medical services and treatments that have been demonstrated by medical evidence to be effective. This matter was reviewed in accordance with Anthem’s medical policy, which is continually updated and relies on scientific evidence published in peer-reviewed medical literature and other factors that show a demonstrated benefit. With our updated policy, and additional information from the member’s physician, it was determined the procedure met our policy and was approved.”
Pisano is glad he advocated for Justin. “This is the best option for our son,” he said.