KANSAS CITY, Mo. — “Denied” is one word that a local family dreaded hearing last week after fighting an insurance battle.
After we aired the original story about the Tranckinos, their insurance company said it was still a possibility their twins would be covered for a surgery they need by a surgeon in Texas. Turns out, they were denied the surgery in Texas, but the insurance company says they can get the same procedure at Children’s Mercy Hospital in Kansas City.
“We kind of feel like they’re just telling us, go here, this is the only thing you can do, we don’t really feel like they’re looking into it like they should be,” said Karla Holton, the mother of twins Blake and Lance.
Last month FOX 4 told you about Holton and Victor Tranckino’s twin boys needing a $100,000 surgery to correct their Craniosynotosis , which is a birth defect where the joints between bones in a baby’s skull close prematurely.
“It’s not an elective surgery, it has to be done,” said Tranckino.
“Their brain doesn’t have any pressure yet, but if it doesn’t get corrected when it should, it could lead to that, and then it could start leading to developmental delays, vision problems, seizures,” added Holton.
After their story originally aired on FOX 4, their insurance company, Sunflower State Health, told them the Texas surgeon was still a possibility. However, last Tuesday that was denied.
“They said it is medically necessary to have the procedure, but it is not medically necessary for us to go out of state because they are saying they can send us to a provider in network, but it’s not the same procedure,” said Holton.
Holton and Tranckino say there are many reasons why they are opposed to this.
“More likely a chance to have multiple surgeries, he uses different dissolvable plates and screws, and then the helmet is what’s reshaping the skull, they don’t actually reshape it, where as in Texas that’s what the surgery does, is reshapes the skull,” said Holton.
The doctor in Texas specializes in Craniosynotosis. Holton says the doctor in Kansas City is a plastic surgeon and does not specialize in this.
“We want to go to the surgeon that specializes in it,” said Tranckino.
In a statement to FOX 4, the insurance company said “Sunflower Health Plan is committed to providing our members with the high-quality care needed to keep them healthy. After reviewing the needs of the Tranckino twins, Sunflower’s experienced medical staff determined that the procedure needed could be and was approved to be performed at Children’s Mercy Hospital, a nationally-recognized children’s hospital. Sunflower undergoes a thorough review process with all cases and in this case it was determined that Children’s Mercy can provide the same procedure with better access to follow up care. Sunflower did not see a medically-necessary reason to send the family out of network when the same procedure can be performed locally by highly-qualified health care professionals. Sunflower has been in constant communication with the Tranckino family and will continue to work with them to ensure their children get the quality care they need.”
“It’s a huge difference when you’re a parent and you’re trying to decide who’s going to work on your child,” Holton said.
Holton and Tranckino feel going to Texas will give their twins the best chance to live a normal life. They are appealing the denial.
