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Mom says 9-year-old with special needs is forced into medication withdrawals by health insurer

Insurance makes refills hard to get
Posted: 6:40 PM, Jul 18, 2019
Updated: 2019-07-18 18:40:27-04
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TAMPA, Fla. — The mother of a 9-year-old living with special needs says her daughter is forced to suffer medication withdrawals because their health insurer delays refills.

“It is very difficult watching your child suffer.”

Lauran lives with autism, a sensory processing disorder and debilitating effects from Cerebral Palsy. But the toughest challenge she faces? Withdrawals from her prescription medication, according to her mother Lisa.

Lisa, who asked that we not use their last name, says doctors prescribed medication to help Lauran deal with violent outbursts triggered by her autism and sensory processing disorder.

She made a call for action to I-Team reporter Jackie Callaway after fighting her insurance company for months to refill the medications.

Lisa says her insurance, Simply Healthcare, delayed dozens of refills over the last six years, forcing Lauran into withdrawals.

“She will scream, she will holler, she will hit.”

Lisa said the company questioned the prescription and dosage, forcing her to fill out paper work and spend hours on the phone every single month just to get Lauran’s prescribed refills.

ABC Action News contacted Simply Healthcare about Lauran’s case. The company responded with this statement:

“Simply Healthcare is committed to providing all of its consumers with the services and support they need to manage their healthcare needs. While we cannot comment on a specific member case due to privacy laws, our dedicated case management team works tirelessly to ensure our consumers receive the best long-term health management and care coordination. In doing so, we must also remain in compliance with all local and federal laws pertaining to medication dosages. In order to remain compliant, there may be certain instances where a dosage change from a member’s provider could lead to a delay in access to medication. When a dosage is changed above a certain level it can cause a pharmacy to reject access; that does not mean Simply Healthcare is limiting our member’s access to medications.”

Lisa said a day after we got involved Simply Healthcare contacted her and offered to approve Lauran’s refills every 25 days, so she does not go without.