Mom fights to have baby's formula covered

Nina Pineda reports for 7 On Your Side.
Seven On Your Side
October 23, 2013 3:24:33 PM PDT
Single mom Jillian Coppola says she's losing the fight to save the life of her baby boy.

"This child can only eat one food and the insurance company is telling me that I can't have it," said Jillian Coppola, a mother.

Since birth, the cute 7 month old has battled a milk allergy so severe his doctor says all formulas cause him to bleed.

The only food he can stomach is a specialized formula called EleCare. There's just one catch. It's very expensive.

The pricey powder costs Jillian $45 a can. Just to feed John-John.

"It is $300 every two weeks, it is $600 a month," Coppola said.

That's a quarter of Jillian's take home pay.

Luckily, New York State's Insurance Law says this type of formula must be covered.

But when she put in for coverage under her prescription plan it was denied.

Denied, not once but three times, even with a doctor's note saying the formula was "medically necessary."

The mother of two was forced to pay in full for formula.

"How can you swing this?" Pineda asked.

"I don't. I've maxed out two credit cards, currently on my third," Coppola said.

The mother's last appeal was to her employer, a major metropolitan hospital that Jillian asked Eyewitness News not name. The hospital's head of benefits said no again.

"I don't know who dropped the ball. Somebody did," Coppola said.

So 7 On Your Side picked it up and ran with it all the way to her employer. After 7 On Your Side showed the law there was success.

"I heard back from my benefits department within hour that the infant formula is now a covered benefit," Coppola said.

That means her stack of bills for $3,000 would all be paid.

"To me it literally keeps a roof over my kids' heads for two more months. It's a life changer for me right now," Coppola said.

Jillian's employer also told 7 On Your Side they changed their policy and would be paying all specialized formulas in the future.

"Thank you, for me, for my family, thank you," Coppola said.

The third time was the charm and that's the big takeaway if you get denied. You have the right to appeal denials.

Make sure you provide a letter of medical necessity, those two words many times proves to be the phrase that pays when it comes to insurance companies.

And if all else fails, call you employer and ask your benefits department if they can help. It eventually did in this case.