Misunderstanding Creates Health Insurance Scare

Imagine having a child who needs surgery to save him from a life of pain and possible paralysis, but your insurance company won't allow it.



That's what a Long Island family faced because of a misunderstanding, reported WNBC-TV in New York.



At first glance, little Michael Schindlar looks pretty much like any other 4-year-old.



Aside from being a little small at birth due to being premature, he grew and developed pretty normally until he was about 16 months old.



"He just got quiet, and he was just withdrawn, he wouldn't make eye contact," said Lori Schindlar, Michael's mother. "You'd call his name and nothing."



It took a few months and several visits to the doctor before the Schindlars got Michael properly diagnosed with autism.



"He was so normal one day," said Lori. "It was like someone went in, one night he went to sleep, and someone took him away from us."



A year or so later, Michael had an MRI because he had suffered two seizures. That's when doctors found Michael also had a rare developmental problem called a Chiari malformation, in which the base of the skull is too small for the back of the brain.



The condition causes compression of the part of the brain called the cerebellum, which in turn leads to a whole host of problems, said Dr. Neil Feldstein, of Columbia-Presbyterian Medical Center in New York.



"Pain at the back of the head, top of the neck, sometimes pain radiating into the arms," said Feldstein. "There can be numbness, tingling, there can be speech difficulties, swallowing difficulty, (and it) can lead to spinal fluid buildup in the brain, in the spinal cord."



To ease the condition, patients undergo surgery that creates more room for the brain to grow. Feldstein assured the Schindlars that such a procedure had a successful track record. But then the Schindlars' insurance company said they couldn't pay for the operation.



They couldn't pay "because there was no peer-reviewed literature out there, studies proving that this type of surgery would help the outcome for a child with autism," said Lori.



That's true. However, the surgery wasn't for Michael's autism, it was for his Chiari malformation. Somehow, there was a misunderstanding between the doctor's office and the insurance company that led them to believe the surgery was for the autism.



At that point, the Schindlars called WNBC for help. After some communication between the parties involved, Michael finally got his vital surgery.



The surgery went well. Children with autism who have had this malformation corrected have often seen their autism symptoms get better.



Two weeks after the procedure, Michael was going from a little cranky to calm to very active.



"We're waiting for the 'Mommy' and 'Daddy,'" said Lori. "That would be worth it all."



Michael's parents said that he's had good and bad days since the surgery, at least when it comes to his behavioral issues. Feldstein said that's normal, adding that it could take a year or more to fully heal.