One Family's Fight Against AvMed Part 2
On Wednesday,Â WCJB brought you AvMed's response, and what people in the medical field and Scoliosis Association have to say about treatment, payment, and Mariah Hamilton's quality of life.
"It's just a little weird. Why pay for something we don't want in the first place when you can pay for something we do want and it's less?" said Mariah.
What Mariah Hamilton and her family want is for their insurance company AvMed to pay for the treatments that allow her to move freely and not have to undergo surgery.
At 13-years-old, Mariah has had more than a dozen surgeries to correct the multiple defects she's had from birth, including her weak heart and the congenital scoliosis that often limits her movement and stunts her growth.
Before she underwent her 14th surgery last year, the curve in her spine was 26 degrees. After, it was 74 degrees. She says she's had enough.
Her family found another option cranial-sacral therapy, and it seems to work.
"I've worked with scoliotic cases where someone gained 2 to 3 inches in height over a year's period of work," said Roy Desjarlais with the Uledger Institute.
The family's insurance company, AvMed, won't pay for the therapy. They say it's "experimental and under investigation." The company says they have strict guidelines they follow before approving care.
"There are a lot of chiropractic manipulation treatments that we do approve, that we cover, so it's just that this particular treatment for this particular condition did not meet our standard," said AvMed.
"Is it experimental? No. It's really been tried and true for easily 80, 90 years, but it's been highly refined for the last 30," said Desjarlais.
Instead, AvMed has approved another surgery spinal fusion with the insertion of rods. The procedure costs upwards of $250,000, and it's something Mariah and her doctors say is very risky and the Scoliosis Association agrees.
AvMed says they are in no way trying to prevent Mariah from receivingÂ the care she needs, but their review board has already denied her request once, and AvMed's medical director prescribed the highly invasive surgery.
The only change Mariah and her family hope for is treatment AvMed will pay for. So far, the family has incurred more than $11,000 in debt.
On July 31st, the Hamiltons will have their second hearing with AvMed to plead their case again.
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