LOCAL LIFE
Page 4 | February 2017
S outh Jordan City Journal
Health insurance help: How to live with it and not without By Mandy Ditto | m.ditto@mycityjournals.com
E
ven though open enrollment for this year has closed, there is plenty of confusion when it comes to health insurance. Though many people may know the basics about deductibles, premiums and copayments, there are always pitfalls — or just deeper questions — people should be aware of. Unfortunately there are times that insurance companies are simply limited or have created policies that limit them with what they can cover, and people aren’t aware until a medical emergency of some kind comes up and they need help. Here are some professionals’ tips, and personal stories from the Salt Lake Valley pertaining to navigating health insurance. What isn’t covered Because every insurance provider is different, it is difficult to say what is typically not covered, but it varies with each carrier. However, if people are asking questions about the conditions they have or may have to deal with before they pin down which insurance policy to use, they can often get the answers they need about which carrier and policy works best for them, said Heidi Castaneda, Small Employer and Individual Plan sales director at Select Health. Often, however, nobody can know exactly what is going to happen to them or their family,
Rachel Nichols and her son Brody, who is in need of an kidney autotransplant, and is waiting for approval from their insurance to cover the experimental procedure. (Mandy Ditto/City Journals)
and they simply need coverage for emergencies in the moment. There are also experimental procedures that insurance companies often don’t cover for various reasons, and needing something like this with no coverage can be costly for anybody. For the Nichols family, this has been a reality over the last several years, as it has fought for understanding about their 15-year-
old son’s medical conditions and health. Brody — or Spencer, at school — was born with hydronephrosis on the left side, which causes swelling of the kidney because urine can’t drain properly. He had surgery at 10 months old, and the family was told he would live a normal life. The family later found out that Brody also had it on the right side of his body, and in May
2015 he was feeling sick again. After several months and a fighting for an ultrasound, they discovered that neither kidneys were draining properly. Surgery was done again on both sides at the beginning of 2016, but Brody still had to have nephrostomy tubes put in during the summer to help the kidneys drain into bags he carries on his back. After several doctors discussed Brody’s condition they decided he needed a kidney autotransplant. “Brody will be the first minor in Utah to have this procedure done; he’ll be the first one at Primary Children’s to have it done, if it gets authorized to be OK,” said Rachel Nichols, Brody’s mom. “University of Utah is a research school, so they have done at least 30 cases on adults, but there’s not enough evidence for children with his diagnosis to prove that this will work, so they’re calling it experimental.” However, because of its experimental nature, the Nicholses’ health provider, Select Health, told them they wouldn’t be able to cover it, due to their policy. The family has been fighting and appealing to gain coverage for the $100,000 to $150,000 procedure ever since so that “Brody can live and be a teenager,” Rachel Nichols said. Because Brody’s right kidney was saved continued on next page…
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