Camille had been born with a congenital birth defect that affected the shape and growth of her skull. A neurosurgeon and a plastic surgeon operated on Camille when she was a few months old, but over the next few years, as she grew, there was increasing obvious deformity of her skull.
The doctors had initially counseled the family that sometimes the initial repair would need to be revised as the child grew. The doctors recently confirmed that Camille, now 5 years old, would require another surgery. The initial surgery required quite a long recovery period, and the parents dreaded putting Camille through a big ordeal if there were alternative procedures. The doctors said that there were procedures being done at other children’s hospitals out-of-state, and that the family should look into all of their options.
Camille’s mother and father turned to a patient advocate to help them get started. The advocate helped the family find and review medical literature comparing two different surgical procedures for this condition and also helped them find doctors with expertise in performing these procedures. After getting a second opinion, the family decided on a surgery that would be best for Camille.
Camille’s mother requested prior approval from their insurance carrier for the second surgery, but was denied based on non-coverage for cosmetic surgery. She turned once again to her patient advocate who helped her gather supporting letters from physicians and write an appeal based on the medical necessity of the second surgery disputing the cosmetic argument.
The advocate supported the family in their treatment decision as well as through the appeal process. Camille’s mother reported: “She empowered us to make sure we were receiving the best care possible for our daughter – that is a priceless gift.”
