PICKENS COUNTY, Ga. — A debilitating infection took away a Georgia teen’s ability to talk, or even walk, for more than a year.
“As parents, we just accepted that he would probably pass, he was that sick,” Amy Whitlock said.
Adam Whitlock was eventually diagnosed with autoimmune encephalitis.
“He spiraled, so we lost him neurologically over a span of eight months. Basically, his brain was on fire. His central nervous system was inflamed,” Amy said.
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But a lifesaving, life-changing treatment brought her son back. Now, their insurance provider is stopping coverage of the expensive antibody transfusions.
“He’s thrived. He’s back,” Amy said.
Adam Whitlock himself, now 18, told Channel 2 Consumer Investigator Justin Gray, “I don’t even remember it. Sometimes it creeps in and it just basically like flashbacks,” Adam said.
For two years now, Adam has received the infusions and consistently improved.
Insurance company UnitedHealthcare covered all the costs of the $38,000 biweekly treatments.
Then this year, his father’s employer switched coverage to a specialty drug pharmacy called Archimedes.
“April 7th of last month, we got a denial,” Amy said.
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The letter from Archimedes calls the Gammagard transfusions, “a non-standard or investigational use” that “will not be covered” and goes further saying “an appeal of this decision is not available.”
“It feels like they’ve written us off,” my said.
When Adam did take a brief break from the infusions last year, he regressed.
Now, he’s set to miss his scheduled treatment Monday because Archimedes won’t pay.
“If I don’t get the medicine, everything kind of just stops. I can’t really do anything. It’s just kind of a slow decline,” Adam said
Channel 2 Action News reached out to Archimedes.
After getting no response from the media contact, we even went on LinkedIn and tracked down their medical director. She didn’t respond either.
You can file a complaint with the state Insurance Commissioner in these kinds of denials. They can often help negotiate on your behalf.
But a lot of big companies have what are called self-insured plans, that by federal law exempt them that from state oversite.
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