PHILADELPHIA (CBS) — Imagine the worry — your child might have to go to bed hungry. The fear was real for a local mom who was looking at the possibility of running out of a special formula for her toddler. So she turned to 3 On Your Side and Medical Reporter Stephanie Stahl for help.
A drink from a sippy cup for 2-year-old Tristan Rivera. It’s formula that keeps him alive. He can’t eat or drink much of anything else because of a condition that causes severe food allergies.
“There’s not really much hope of him ever recovering from it,” said Amanda Rivera, Tristan’s mother.
They depend on special formula that they were suddenly forced to ration.
“We’re giving him two scoops instead of four,” said Amanda.
She was facing a nightmare, not being able to get her sick child enough nourishment.
“I was afraid he was going to go into the hospital or even die,” said Amanda.
They were forced to cut back on the formula when she went to order more and was told by her pharmacy that it was no longer covered by insurance. It had been covered before, and nothing had changed with her policy, so she called the insurance company, UnitedHealthcare.
“I let them know that this is a medical necessity. He needs this formula,” said Amanda.
UnitedHealthcare told her the formula required a re-authorization from Tristan’s doctor, which it then tried to obtain. But when Amanda didn’t hear back, she called the company again, and was told the doctor didn’t respond.
Stephanie Stahl said to Amanda, “They said that they didn’t get the paperwork.”
Amanda replied, “Okay.”
Stephanie Stahl asked Amanda, “And you say?”
Amanda replied, “We did, we sent it. I know my doctor did. She let me know everything she was doing.”
Amanda can’t afford to buy the formula that would cost nearly $500 a month. She got desperate and turned to CBS 3 for help.
“We were told it was going to take two to 45 days to even get looked at,” said Amanda.
But soon after we called, UnitedHealthcare reached out to the doctor again, got the necessary forms, and expedited the approval process.
“I don’t think that it would have gotten resolved this fast if you guys did not step in,” said Amanda.
Now Tristan is stepping out, playing and carefree, with a relieved mom, who doesn’t have to worry about taking care of the basics for her toddler.
“Extremely happy. I’m ecstatic about it,” said Amanda.
Reported By: Stephanie Stahl, CBS 3