LETTER TO THE INSURANCE FROM THE MOMMY

October 1, 2012

CVS Caremark

Prescription Claim Appeals MC 109

PO Box 52084

Pheonix, AZ  85072-2084

RE:      Plan Member Name:  Carter Richardson

         Plan Member ID:  

Dear CVS Caremark appeals department,

I have received your letter of denial for our request for the medication, Omnitrope, for my son, Carter.  Dr. McCormick will be sending in another letter to appeal this decision, but I thought it might be beneficial for you to hear directly from me, his mother.

I’m sure you’ve already received a complete medical history on Carter and you are aware of the struggles he’s already endured.  So, what I want to tell you is about how this is affecting Carter and our family on a personal level.

I started getting concerned about Carter’s growth when I realized at the age of 6 he was still able to wear shoes I had bought for him when he was three.  As I paid closer attention, I saw that his clothing was the same story.  That didn’t seem normal and it has not gotten any better.  When we saw the doctor I voiced this concern.  That was about a year and a half ago.

We have not taken the decision to put him on Omnitrope lightly.  It has been a heavy burden for us, but knowing that this medication will help him in so many ways is why we have made the decision to move forward. 

Carter is less mature, considerably shorter and still looks like a chubby baby in comparison to his peers.  I recently pulled a photo out that was taken in 2009. I showed it to my husband and asked him if he could guess when it was taken.  When I told him it was taken three years ago, he was shocked.  It looks like it was taken recently.  Carter is not growing and though his bone age isn’t delayed now, it is only a matter of time before it will be. 

The fact of the matter is that the earlier you start a child on growth hormone replacement, the better the results.  His pituitary gland is producing little to no growth hormone and it is inevitable that his bone age will fall behind.  If we are made to wait until this happens before we are able to initiate this medication, we are losing precious time that we will never get back. 

Please consider my son, his future and his wellbeing when you make your decision to approve our request.  Thank you in advance for your consideration.

Sincerely,

Shawna Richardson

Carter’s Mommy