Surgery approved for 7-month-old after being originally denied due to insurance questions

Published: Jan. 4, 2023 at 6:53 PM CST

MEMPHIS, Tenn. (WMC) - A 7-month-old Memphian will now have a chance to save his hearing, after being approved for a surgery that was originally put on hold by Le Bonheur Children’s Hospital.

Nathan Hart, the 7-month-old, was checked into Le Bonheur on December 19 with bacterial meningitis.

Nathan’s parents, Melanie and Tyler told us Nathan had severe hearing loss.

“It affects the liquid in your ears,” Tyler said, relaying what doctors had told him. “What will happen is that liquid will turn to bone, and (doctors) will not be able to do the surgery if it turns to bone.”

The solution to this is bilateral cochlear implant surgery, and the Harts said Nathan’s surgery was set for Tuesday morning.

The problem with this is the surgery was scheduled last week, when Blue Cross Blue Shield of Tennessee (BCBST) was still accepted at Methodist Le Bonheur Healthcare (MLH) facilities.

BCBST and MLH failed to renew a contract by the Dec. 31, 2022 deadline, and as of New Years Day BCBST customers are no longer covered at MLH facilities, which included Le Bonheur.

The Harts said they were given no advance notice of this possible contract fallout when they scheduled the surgery last week.

“(Le Bonheur) said surgery is set for Tuesday,” Melanie Hart said. “They come in on Tuesday morning and told us ‘we’re going to get (Nathan) set.’ Then, and ENT came in and said ‘I’ve done all I can do, but due to insurance, we can’t do the surgery.’”

The Hart’s situation, we’ve learned, is unique compared to other BCBST customers.

The family had just moved to the Memphis area from Oklahoma a few weeks before Christmas, Nathan being admitted to the hospital shortly after the move.

Tyler had an employer-sponsored health plan through Blue Cross Blue Shield of North Carolina, and when the family moved to the Mid-South Tyler left that job and BCBSNC behind.

They immediately transitioned to an out-of-pocket plan, hoping to retain BCBSNC through COBRA, but the Harts tell us because of their geographic location they were given a plan through BCBSTN.

When they received the news of Nathan’s surgery being pushed back, the Harts were frantic.

“If he doesn’t get (surgery) soon, (Nathan) will be deaf for the rest of his life,” Melanie said.

With such a short window to get Nathan the surgery he needed, they offered to pay out of pocket with a payment plan.

Tyler told us the hospital wouldn’t allow this, due to the high cost of the procedure.

“$60-something-thousand an ear,” Tyler said. “They want to make sure it gets paid, so they want to get insurance involved as much as they can.”

The Harts said they reached out to BCBST multiple times but said they felt they were being given the run-around.

Le Bonheur is the only hospital in the area that can perform this surgery, and with such a short window to perform the surgery, driving to another state for care was not an option.

“We don’t even know who to go to or who to speak to,” Tyler said.

“As a children’s hospital, I feel like you should do right by the child,” Melanie said. “Why should (Nathan) have to suffer without hearing when it’s completely preventable when he can have surgery to fix it?”

Action News 5 reached out to BCBST for answers on this.

A spokesperson told us the Harts’ contact information had been forwarded to “the appropriate teams for follow-up.”

We were also given the following statement for what BCBST customers who received care within the MLH network should do while negotiations are still ongoing:

Wednesday evening, Melanie informed us that BCBST did, in fact, contact her and Tyler.

It was determined that they were, in fact, customers of BCBSNC and were directed to the correct insurance plan.

They had approved the surgery for Nathan and said it would be covered under insurance.

“Chief Medical Officer came and spoke to us saying they are doing it,” Melanie sent via text. “Doctor’s ENT surgeon said ‘I don’t know who contacted the news, but it worked.’”

Nathan’s surgery is set for Thursday morning at 11:00 a.m.

The Harts have set up a GoFundMe to pay for any expenses insurance does not cover.

At this time, there is no indication of when a new contract will be approved between MLH and BCBST.

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