Jay, a 36-year-old working father of two young children, was a Wisconsin State employee. Jay had been recently divorced and his ex-wife had moved out of state. One of his children, Damion, was diagnosed with a rare form of leukemia.
Damion’s doctor felt that Damion would best be served at Mayo, as they have a unit that specializes in childhood cancers. The doctor provided the required referral, but Jay’s HMO denied coverage, stating: “comparable facilities and providers are available within network.”
Jay was just about ready to drive Damion to Mayo and deal with the costs later when he heard about the Center for Patient Partnerships. He was hesitant, but he called.
A patient advocate helped Jay file an expedited insurance appeal and coached him on asking Damion’s doctor to write a letter explaining why such a rare form of leukemia should be treated at Mayo. The advocate also helped Jay find a support group for parents of children with Cancer.
