Dear Cigna,
My name is Sarah Thompson, and I am writing to you as a distressed parent of my 4-month-old son, Leo, who relies on Elecare for his nutrition. This is not a luxury choice for us; it is a medical necessity. My son suffers from a severe cow’s milk protein allergy (CMPA), which dictates his need for this specialized formula.
Leo was born prematurely due to my health issues during pregnancy, specifically preeclampsia, which resulted in a medical induction. Before you raise the age-old debate of breastfeeding being best, let me clarify: Leo could not latch. His challenges were compounded by bilateral buccal ties, leading to an inability to latch onto a bottle as well. Despite already having two children at home, my determination to provide him with breast milk led me to exclusively pump. Unfortunately, even my milk, which is often touted as the best for infants, caused him immense discomfort and suffering. For the first month, he cried incessantly, and his stools were concerningly loose, often containing blood and mucus. Breastfeeding was simply not an option for us.
After weeks of struggle, we were referred to a gastroenterologist who confirmed our fears: Leo has a severe case of CMPA. The symptoms can range from mild digestive discomfort to severe reactions like diarrhea, bloody stools, and eczema. In Leo’s case, he cannot tolerate even the smallest amount of cow’s milk protein, whether it is whole or broken down.
Upon the recommendation of our GI specialist, we began using Elecare, along with antispasmodic Levsin drops. To add to our concerns, the doctor also confirmed that Leo suffers from severe acid reflux. As a parent, witnessing your child endure such pain is heart-wrenching.
Financial Burden
Now, let’s discuss the financial aspect: a single 14.1 oz can of Elecare costs $45, and it lasts Leo only 2-3 days given his current intake. This expense will only increase as he grows. By contrast, a can of standard infant formula costs roughly $12-14 and comes in larger sizes with bulk pricing. When I reached out to your customer service team, I was informed that many medical-grade foods and formulas are covered under our plan, yet Elecare was not included. This left me perplexed and frustrated. Are we really expected to bear the burden of $450 or more monthly without assistance when other formulas are readily covered?
Our dedicated gastroenterologist went above and beyond, providing us with samples, coupons, and a thorough submission to Cigna, which included prescriptions for caloric intake, a pre-authorization letter, and a letter of medical necessity. Despite her efforts, we were met with a denial because Elecare is only covered for specific diagnoses, specifically inborn errors of metabolism, which does not include CMPA.
This arbitrary restriction is infuriating. Leo needs this formula for his survival, and yet you refuse coverage because of a technicality. From my perspective, the risk of failure to thrive and dehydration looms ominously without this essential nutrition. It is disheartening to think that had Leo been hospitalized due to these issues, you would readily cover those expenses rather than contribute proactively to his health.
Call for Change
In Texas, it is mandated that insurance companies cover baby formula. With the significant contributions we make to our family plan—over $1200 monthly—it seems only reasonable that you would assist with this vital medical-grade food necessary for my son’s survival.
I urge you to reconsider your decision and support families like ours in their time of need. It is time for a change, both in policy and in understanding the diverse needs of children with medical conditions.
Sincerely,
The parent of a child with a food allergy