The Tribune

By RASHAD ROLLE

Tribune Staff Reporter

rrolle@tribunemedia.net

HER nose and mouth covered by a protective face mask, Iyanda Hilton wrapped herself in a warm blanket and rested alongside her mother in the Bone Marrow Centre at the Holtz Children’s Hospital in Miami, Florida.

On March 20, after 12 years of suffering, she was about to have a potentially life-changing bone marrow transplant that was years in the making.

After an acute chest syndrome in 2014 placed her in the Intensive Care Unit at Doctors Hospital for several days, her parents, Ian and Yolanda Hilton, realised she needed urgent attention and they pursued the transplant as the primary remedy for curing her sickle cell anemia.

The 12-year-old girl’s team of medical professionals greeted her anxious parents one-by-one on the morning of the planned procedure, offering comfort and words of encouragement.

But it all proved futile. Iyanda never received the transplant.

On March 20, when Sanus Health Corporation - a third-party administrator that processes claims for Colina Insurance Limited - sent the hospital a sheet pre-authorising the $500,000 treatment, it indicated that it would not pay for a preparatory drug called Compath.

According to Ms Hilton, the hospital responded that it would use an alternative drug instead and asked the insurance company if that would be covered.

“Sanus then told them they would send them a letter of some sort,” Ms Hilton claimed in an interview with The Tribune.

For eight hours the Hiltons waited in the Florida hospital for a letter that never arrived.

Rather than let Iyanda spend the day in the hospital at a cost of $4,000, the hospital instructed the family to leave the treatment centre and to return only when an update from the insurance company was received.

“The doctors and medical professionals lined the halls of the hospital as we left,” Ms Hilton told The Tribune yesterday, describing overwhelming feelings of embarrassment. “They told us they’ve never seen anything like this before.”

The frustrated mother returned to New Providence three days later for a meeting she said was arranged by Colina.

It was then that the parents received information that still leaves them angry and shocked: Iyanda’s treatment would not be covered by their insurance policy.

“Colina told me that there’s a cap of $250,000 for people with congenital diseases,” she claimed. “My question is, if this is the case, why did they give us all the prior authorisations every step of the way, allowing us to get to this point where we were literally in the treatment centre and my daughter had already been admitted?”

Insurance companies are not obliged to provide coverage outside the terms stipulated in their contracts with clients.

But Ms Hilton said Colina authorised her daughter’s treatment after extensive reviews, only to deny coverage to Iyanda on the very day her procedure was set to begin.

She said: “How could you do your due diligence, tell us all the way through that the treatment has been authorised, and then deny us the coverage minutes before the treatment was to begin?”

Documents obtained by The Tribune show that the insurance company appeared to provide prior authorisation for the treatment, although the company noted in the fine print that “authorisation is not a guarantee of payment”.

On March 17, a Jackson Memorial Hospital international patient co-ordinator sent an “urgent” email to a representative of Sanus Health seeking confirmation that the insurance company would authorise the procedure.

“Everything is scheduled for the admission (of Iyanda) on Monday,” the co-ordinator wrote.

Noting that Iyanda was advised to be at the hospital at 10am on March 20, the co-ordinator requested that the authorisation process for her be expedited so she would not be “held at (point of service) due to non-financial clearance”.

In a subsequent email sent an hour and a half later, the Sanus Health representative wrote back saying the case had been approved.

She included in the email an authorisation number for the case and said admission of Iyanda would be covered at 100 per cent, requiring just a $500 co-pay.

Why Iyanda was later denied coverage is unclear.

In a statement to The Tribune yesterday, Colina did not respond directly to questions about the issue.

“Colina Insurance Limited advises the media and the public that it is the company’s policy, and out of the utmost respect for its clients, to maintain the privacy of its insured,” the company said in a statement. “As such Colina will not disclose any personal information regarding the insured, his or her medical history, or medical coverage to the media.

“In all cases, the insured and the insurer are both bound by a policy agreement. Colina will continue to work with its clients to provide the best care and coverage within the confines of each policy agreement.”

The Hiltons have not given up hope that their daughter will be given treatment, and Iyanda remains in Miami while the family hopes to reverse the insurance company’s decision.

In the meantime, they have started a GoFundMe page for Iyanda’s treatment: www.gofundme.com/IyandaHilton.

Asked if they will seek legal remedies, Ms Hilton said she is uncertain.

“I don’t want to spend $1 on an attorney,” she said. “All the money I have or that persons could support us with in this effort needs to go towards my child. I don’t wish to fight with anybody. All I want is for my child is to receive the procedures she needs.”