Typo leads to insurance lapse for paralyzed, bedridden man

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MEMPHIS, Tenn. -- A Mid-South mom wants answers after she says her paralyzed and bedridden son's insurance coverage was cancelled over a clerical error.

Now, she fears a typo could mean the difference between life and death for her son.

Antonio Fletcher, 24, requires around-the-clock care after a shooting in 2011 nearly severed his spinal cord and left him paralyzed from the neck down.

"He's got to have the life-support machine 24 hours a day," said his mother, Cynthia Carruthers. "If you take it off of him, he's going to pass out and he's not breathing, so therefore he will die."

Up until Monday, Fletcher's insurance company – TennCare – was covering the cost of his two private nurses.

That's when Carruthers says Elk Valley Health Services, the company that provides his nurses, called to inform her they would no longer be able to care for her son because of a lapse in his coverage.

It turns out, TennCare had her address wrong in its database – off by one digit.

A customer service representative explained what happened.

"She was like, I see where the problem is," Carruthers said. "It was one number off on your address. She wasn't telling no story. [The mail was addressed to] 2559. My address is 2569."

Carruthers tells WREG because of that typo, the renewal form for her son's insurance was never delivered, so it was cancelled.

And getting it reinstated won't be a quick fix.

She says she filed an eligibility appeal but was told a resolution could take up to 90 days.

"I've been up for three days," she said. "No sleep, trying to take care of my son because they're telling me it's going to take 45 to 90 days to even get him completely back on TennCare."

Now, she's worried the machines that keep her son alive will be taken away next.

She's pleading with TennCare to do whatever it takes to get her son's coverage reinstated immediately.

"What am I supposed to do? What am I supposed to do?" she said. "What y'all want me to do? Y'all want me to get on my knees and beg? Because that's what it's like y'all are asking me to do. ... My son is completely dependent on his ventilator."

In a statement Wednesday afternoon, TennCare said:

TennCare is a taxpayer funded program and all enrollees are required to re-verify their eligibility on an annual basis.

TennCare enrollees are also informed upon enrollment and reminded periodically thereafter of their responsibility to inform TennCare of any address change. Even though a member may update their address information with their provider it is essential they also make that update with TennCare. This ensures that, among other things, they will receive the annual request for the documentation necessary to determine whether they remain eligible to continue receiving benefits.

Individuals who do not fulfill these responsibilities (to ensure TennCare has their current address and to respond to requests to verify information such as family income) do risk losing these taxpayer funded benefits. If an individual loses coverage for such reasons and later does respond with the appropriate information and is determined to continue to be eligible for benefits, TennCare benefits will be reinstated, with or without a gap in coverage, depending on the specifics of the individual situation.

That being said, a renewal packet was mailed in February 2017 to the address on file for Antonio. The packet was returned as undeliverable with no forwarding address. Since that time there has been an address update initiated by the family, which will allow them to appropriately receive important communications regarding eligibility and benefits in a timely manner.

Elk Valley Health Services also released a statement, saying:

The well-being and health of our patients and their families remains the top priority for Elk Valley Health Services.

In this instance, the service provider and insurer are linked in regard to provision of care. When any patient is removed from TennCare – or any insurance coverage – we can no longer obtain authorization for services from the Medical Care Organization.

Elk Valley Health Services is ready to work with TennCare to explore options and find a solution that will enable resumption of service as soon as possible.

Because of federal HIPPA regulations, and our company’s strict policy to safeguard the privacy of our patients, we cannot comment further on the specifics of the situation.

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