Child born with ‘holes’ in heart can’t get life-saving device as insurance refuses to cover it

A seven-year-old was denied a life-saving device after his insurance company refused to cover it because medical evidence did not support his use.

Decker Sharp, of Nashville, Tennessee, was born with an atrioventricular septal defect and pulmonary stenosis, which means he has holes in his heart and the pulmonary valve is particularly narrow, CBS reports.

Sharp is a certified cardiologist for exercise, but warns that if he goes into cardiac arrest during exercise, posing a risk to someone with the condition, he will likely die. But a device called an automatic external defibrillator (AED) can save his life.

The device can cost up to $3,000. The Sharp family is insured by Anthem, one of the nation’s largest insurance companies, which refuses to cover the device. Anthem says current medical evidence does not support the need for an AED for someone like Sharp.

This put the family in a stalemate. While they want their children to continue exercising, there is a risk of death if they do not have the device.

Sharp had surgery to treat his condition when he was eight months old.

Years later, at the age of three, a mass developed in his heart that was causing problems with pressure and blood flow. He needed a second open heart surgery.

Although she is doing well now, her family fears the worst as her heart problems persist.

The ascending aorta, the largest blood vessel in the child’s body, begins to thin and builds pressure on his heart.

This can eventually cause the vessel to rupture, an emergency that often leads to death.

Sharp also runs the risk of cardiac arrest if exerted, which he often does while exercising.

Sharp sports allowed by your cardiologist. Doctors recommend that the family keep the AED handy while exercising in case they experience life-threatening cardiac arrest.

Cardiologists recommend that parents have an AED on hand, a device that can shock the heart quickly and restart it in an emergency.

While some people have the device surgically implanted into their hearts, Sharp is looking for a version to take with them just in case.

This makes the device much cheaper, coming in at between $1,000 and $3,000 for the device. The surgery can raise the price up to tens of thousands.

However, Anthem refused the prescription, saying it was not supported by the medical literature.

“Current medical evidence does not support the fact that antiepileptic drugs benefit patients with atrial septal defects, and as a result these devices are not covered by the family health plan,” the company told CBS.

Sharp’s family say they were disappointed but not surprised by the insurance company’s choice.

Sharp’s insurance policy, Anthem, refused to cover the purchase of the device, which could cost $3,000. They say the medical literature does not support its use for his condition.

“We are disappointed with Anthem’s decision, but unfortunately not surprised,” the family said in a statement.

“We remain hopeful that this will initiate a conversation to set parameters when AED coverage is available.

“They definitely save lives. We also strongly believe that healthcare decisions should be made by doctors, not insurance companies.”

Insurance companies that could refuse doctors’ advice has become a controversial, stressful, and sometimes deadly practice.

Companies reserve the right not to provide coverage for certain medications, procedures and other costs if they do not deem it appropriate.

However, insurance professionals are often not medical professionals, creating a situation where a doctor can recommend a treatment, only to be rejected by a non-specialist.

The patient can still receive the treatment, but must pay for it out of his own pocket.