Mom fights for son after chemotherapy medication denied - CBS46 News

Mom fights for son after chemotherapy medication denied

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(Source: WGCL) (Source: WGCL)

What do you do when your doctor says yes, but your health insurance says no?

A Newnan mom says doctors at Children's Healthcare of Atlanta prescribed her son a life-saving medication, but when she went to the pharmacy to fill the order, she was told the medication wasn't covered by her insurance.

She refused to take "no" for an answer. She took matters into her own hands to save the life of her son.

Katie McCoy says after repeatedly being told no, she did everything she could think of, including contacting the media. She even looked up e-mail addresses of executive from her pharmacy company, and in the end -- after weeks of frustration -- she got results.

Mattie McCoy, 9, spends a lot of time in the car these days. Several days a week his mom takes them from their home in Coweta County to Atlanta.

"Matthew has Fibermitosis Type 1 and basically it is a genetic disorder where tumors can grow on nerve endings," says his mom. 

Tumors now cover Mattie's spine.

You would never know it just looking at his smiling face, but he desperately needs chemotherapy to shrink his tumors. Doctors prescribed a medication called mekinist.

"We had three leading experts saying that he needed this, and yet the insurance company was saying we know more than your doctors," says his mom. "I was infuriated."

Under FDA labeling, the medication is not approved for tumors. The pharmacy told her if she wanted the medicine, she would have to pay out of pocket.

"At the highest dose, it is over $10,000 a month," she says. 

Her team of doctors filed an appeal with CVS Caremark, which handles pharmaceutical benefit's for the family's insurer, United Healthcare.

"That appeal got denied," she says. 

Mattie's mom says several more rounds of appeals were also denied, and she was about to give up hope.

"All I could think is I've got to try one more time," she says. "I hunted down the email addresses of every single CEO at CVS Caremark and I pled my son's case...and I told them that my son's life is literally in your hands."

One of those executives responded.

"He emailed back and said it was approved," she says. "I cried, I screamed, my husband thought something had happened to one of the kids, but I had nothing but pure joy."

She hopes that other families can learn from her trying experience and never take no for an answer.

We reached out to United Healthcare, who wouldn't answer any of our questions, citing HIPPA laws. They would not even tell us if they use CVS Caremark to handle the pharmacy benefits.

CVS Caremark did send us a very brief statement when we questioned them about the denial, saying it has since been approved.

Mattie should have his first dose of the chemotherapy medication by Thursday night.

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