Local News

Blue Cross approves Coats girl's treatment after online appeal

Posted June 12, 2012
Updated June 13, 2012

Map Marker  Find News Near Me

— After two months of battling for insurance coverage for their 12-year-old daughter's rare condition, a Harnett County family turned to social media recently to ratchet up pressure on Blue Cross Blue Shield of North Carolina.

Faced with the bad publicity of a growing Facebook campaign and the possibility of the state Department of Insurance ordering coverage, Blue Cross agreed Tuesday to pay for Ellen Whittington's treatment, the girl's father said.

About six months ago, Ellen developed auto-immune encephalitis, a rare condition in which the immune system attacks the brain, causing loss of language and motor skills. She can now only stomp her feet and clap her hands.

"This is not what we started out with," said her father, Brian Whittington.

Dr. William Gallentine, a Duke University pediatric neurologist, prescribed an intravenous treatment of immune globulin, or IVIG, that cost nearly $60,000.

Blue Cross denied coverage, arguing that there wasn't enough medical evidence to prove the treatment might help Ellen. Two subsequent appeals of the decision also were turned down.

"I have to believe in my heart that had she had this IVIG treatment when it was originally prescribed, then she may be running around kicking a ball and singing and dancing again," Whittington said.

A Facebook page detailing Ellen's condition and the family's insurance plight sprouted up over the weekend and had 822 "likes" by Tuesday evening.

The family also shifted its appeal to the state Department of Insurance, but Blue Cross offered Tuesday morning to pay for the IVIG treatment on a trial basis if the family withdrew that appeal, Whittington said.

blue cross blue shield Blue Cross says appeal system for denied claims works

"We were aware of this child's plight and had been working on it," said Dr. Don Bradley, chief medical officer for Blue Cross. "Clearly, the social media kind of brings more light to it, but the process was already in motion."

Blue Cross denies less than 5 percent of claims, and the unusual nature of Ellen's illness made the decision difficult in this case, Bradley said.

"When you look at this on the front line and you get these rare clinical syndromes – and as tragic and tough for the family as they are – we’re going to make sure that the family and the patient aren’t exposed to things that aren’t going to be effective, and frankly, harmful," he said.

Ellen is scheduled to begin her treatments at Duke on Wednesday.

"I didn’t set out to harm Blue Cross Blue Shield in any way with this. I just wanted my daughter to get the treatment she needed," Whittington said. "Not knowing if and when she was going to get treatment (and) not knowing how we were going to pay for it if Blue Cross Blue Shield didn't come through, that was the hard part."

Bradley said the case shows Blue Cross' system works.

"This was an expedited appeal – handled in relatively short fashion – and the patient is now getting the treatment that may or may not help them, but it’s at least the best effort as we in the clinical science know," he said.


This story is closed for comments.

Oldest First
View all
  • twsw Jun 14, 2012

    For what reason do we pay medical insurance if not to prevent losing everything we've worked for? Also, no one has posted here that state employees do pay premiums out of pocket for dependent care coverage just like anyone else does for insurance offered as a benefit of employment. Unfortunately the rates have gotten so high I've had to switch our dependents over to a plan with less coverage offered by my spouses's employer. All you taxpayers out there who resent my WELL EARNED benefits can now celebrate! Meanwhile I'll keep trying to prevent bankruptcy over medical co-pays/coinsurance left over from hospitalizations/procedures in 2009!

  • Ambygirl Jun 14, 2012

    Good for Mr. and Mrs. Whittington! They didn't just sit back and take no for an answer! I applaud you for fighting the big guys and getting what you need for your daughter! Best wishes for success and for healing so that your daughter can live a wonderful life!

  • morebadnews Jun 14, 2012

    I am really not sure what to say to you all who are judging Mr. and Mrs. Whittington and the actions they took to help their child. He has asked that anyone who comments be with dignity and respect so I will only say that in my opinion they did the right thing and got the right outcome. Their daughter is receiving the help she needs and that is what matters.

  • bandit152 Jun 14, 2012

    Well-Well, Were do I begin? I have read all these statements that have been posted and it is sad. First, on the behalf of Mr. & Mrs. Whittington, I'd like to thank WRAL for their coverage for both the Whittington home & BCBS insurance company. Second, I'd like to say/tell everyone that Mr. Whittington is making it a point to tell all of FB/WRAL/BCBS that this was not meant to be grudgeful or slandering, he just wanted the best for him daughter. NOW from me & my comments--How dare some of your say and post what you posted. I'm sorry for the few of you who posted "I didn't receive any help" (let this be a lesson to all), you can receive/get help if you use your GOD giving brain and think/react. And for the ones who said "I'd sell my home, car, boat, my momma, whatever", they tried to pay/set payments up but were rejected because they had health insurance. I'm sorry for the few, who commented and posted so ignorantly, that you wer raised in a home where your parents did not care. (Danny)

  • barnharj Jun 14, 2012

    Just like ble Cross, more worried about its profit and loss margin and the big salary and bonus for the CEO than the life of a little girl. Time that these insurance companies were regulated again. NOn-profit. CEO's make no more than 150K. NO bonus'!

  • storchheim Jun 13, 2012

    Wow, such rage! All because I said they should take care of their own daughter?

    "How dare you?"

    I'll overlook that.

    "The husband and wife both taught me in high school years ago."


    "These are good people, who love their daughter."

    Also irrelevant.

    "You would do the same thing if your child was going through this."

    I'd appeal and appeal WHILE getting treatment. I'd sell the house and move in with family. I'd sell the car and beg rides. I'd take another job. But I believe in keeping my word and my agreements. Then I'd try to accept it as part of life.

    "And you know what, the fb campaign worked. It worked because their insurance was going to deny their precious child treatment, until this grew to the media airwaves."

    Until BCBS was railroaded.

    "If you signed an agreement to an insurance company and you're telling me YOU know ALL the details to it, you are full of it."

    How dare you! Not only angry and presumptuous, but ignorant and incorrect.

  • twsw Jun 13, 2012

    Re: Loveapex's posts
    Not sure what has happened in your case and so sorry to hear that you and your family have been through what you must have. Not sure what coverage you have either. My sincere prayer for you and your daughter is that you finally get the answers and care your daughter desperately needs as well. I can only imagine your frustration with seeing this happen for someone else. I believe I would have to express that frustration too. Please know that you are in our family's thoughts and prayers and that your situation will be lifted up amongst our church family. I am part of Ellen's family(not a parent). While we do not know your pain personally, we can identify with your frustration. You are justifed in your anger, but I find your accusation of bullying the insurance company to be unfair and misplaced. You are entitled to your opinion, but I can tell you the decision to seek help was not entered into lightly and was considered prayerfully. I wish you the very best!

  • loveapex Jun 13, 2012

    I know what my insurance covers, I know what it doesn't! If I want something for my child that is NOT covered....I pay for it!!

  • loveapex Jun 13, 2012

    OneLove - You don't know me or my life. My daughter has been ill for no less than five years and no one across the nation can figure out what is wrong with her. Medical bills rounding 100k. Much of it from my pocket to pay for experimental tests and treatment. You know nothing!

  • Plenty Coups Jun 13, 2012

    "A gall bladder that's been bothering you off and on for a few months can wait if necessary"

    It can wait but as our doctor said, if you wait until you have to go to the ER, not only will it be much more expensive, it could lead to serious, life threatening complications.