NORFOLK, Va. - A Norfolk man has claimed a small victory in the fight for his medical coverage.
News 3 Problem Solver Erin Miller shared Ryan Featherer's story in early July. He's a beloved orchestra teacher in Norfolk who lives with multiple sclerosis, a chronic disease that affects the central nervous system.
"You feel it as soon as you put your feet on the ground and it doesn't stop. It just never stops," said Featherer.
The father of two said he has tried everything to numb the pain, including a week-long clinical trial where a spinal cord stimulator was implanted in his body. He said it was the only thing that gave him relief since he was diagnosed in 2002.
Despite this, and 1,200 pages of other attempted treatments, his insurance company said the procedure was not medically necessary.
He followed the appeals process until he exhausted all options. During this time, he learned about the Patient Advocate Foundation, a nonprofit that helps people with serious health conditions.
"I call my case management staff, like, they're just little mini investigators," said Erin Bradshaw, Chief of Mission Delivery for Patient Advocate Foundation.
Erin Bradshaw is the chief of mission delivery for the Patient Advocate Foundation. She said case managers advocate and mediate on behalf of patients so they can get the care that they need.
"If your doctor feels that you need this therapy, or treatment or medication or whatever it is and the insurer has a disagreement. You know, pursuing your rights and pursuing opportunities to repeal is really an important piece of it," she said. "It's complex, it isn't easy, and that's why we're here to provide some help."
Services include case management and financial assistance, covering everything from paying for treatment, using employee benefits and getting reimbursed.
"It's administratively heavy, and it can be very stressful for someone who is really being halted or a delay in their care," she said.
News 3 Problem Solver Erin Miller asked how often patients give up and don't pursue their claim further after it is denied.
"I'm sure it's pretty robust, [but] whether a person understands it, I think that's where the challenge lies, because understanding health insurance in itself is very, very complex, very challenging," Bradshaw said.
Featherer has known since day one how challenging the process can be.
"He originally was approved by his prior and health insurance. And then the midst of it all, was scheduled for a procedure in March. But his his insurance changed in January, which initiated another prior authorization process," said Bradshaw.
Featherer said if he had known about PAF earlier, his outcome could have been different.
"I think this would be [different]. We wouldn't be sitting here right now. I think I would be running around going crazy, happy and everything. You know, I think this would've been done in March if not sooner," he said.
Ultimately, he said it wasn't until his students started a letter-writing campaign, and Alec Baldwin caught wind, that the insurance company reversed their ruling.
"I'm doing this for the person who can't do it for themselves. I said I'm lucky, I have a village. I'm very, very lucky and blessed for that aspect and I said, but what happens to the person that doesn't have this?" Featherer questioned. "Don't stop fighting, don't stop fighting."
If you are having issues with your insurance company and you would like to contact the Patient Advocate Foundation, located in Hampton, call (800) 532-5274 or click here.
His insurance company will cover 80% of the cost, but Featherer will still be responsible for 20%. If you would like to donate to his GoFundMe, click here.
Featherer was scheduled for the surgery on July 27.
