Family Fights HMO to Save Boy's Life
By Cecilia Green
Published on November 07, 2005
Family sues Health Net when they refuse care to a four-year-old with a rare form a dwarfisim.
Jack Zembsch, a 4-year-old from Moraga, California, has a rare form of dwarfism known as metatropic dysplasia or MD. MD is so rare in fact, that only one person a year is born with it in the United States.
The disease will cause Jack's bones to become soft and eventually stop growing, while the rest of his body will continue to develop. Therefore, his lungs will eventually be too large to fit in his rib cage. Even a fall could cause Jack to snap his spine. Without treatment, Jack will die.
Health Net, Inc., Jack's HMO, refuses to cover the out-of-network costs for Jack to see the one doctor that can save his life, Dr. William Mackenzie. Dr. Mackenzie, who works at a Children's Hospital in Delaware, is the only person in the country with the expertise to save Jack's life.
For more than eight months, Jack's family has requested out-of-network care from Health Net, each time making it clear that this is the only option to save Jack's life, but each time they are rejected. Jack's primary care physician even wrote to the HMO explaining the situation, but was unsuccessful.
Each time a request was made, the HMO waited the full 30 days granted by law before they replied with an excuse to deny coverage. HMOs do not want to pay for expensive treatments or treat patients with rare diseases that may cost them more money.
Now, the family is going to file a lawsuit against Health Net. It may be the only way this family can get the HMOs full attention.
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