Girl, 9, has long, painful wait for new prosthetic leg
Father blames insurance company for lack of timely approval
PEMBROKE PARK, Fla. – Mithara Bateau is like a lot of 9-year-old girls. She loves to play outside and jump rope, but for her, it's more difficult than it is for most. She was born without a fibula bone in her right leg, meaning it doesn't grow properly and is several inches shorter than her left leg.
She said when her classmates make fun of her, she has a ready answer.
"All the kids keep bullying me for my feet," Mithara said. "When a girl (asked) what happened to my feet, I said, 'I (was) born like that.'"
Her condition comes with annual surgeries, said her father, Charles, a single father who has stood by Mithara every step of the way. He gets health insurance through his job at Target stores, where he's worked for 16 years, but he said the costs of those surgeries, often two a year, forced him to file for bankruptcy last year with hospital bills mounting to more than $200,000.
Meanwhile, it's been a steady stream of pain for Mithara.
"They keep hurting me," she said when asked about going under the knife.
There's also the cost of a prosthetic leg, which includes a false foot, which is literally what keeps her on an even keel. The problem is that Mithara is a growing girl, so she usually needs a new one about once a year. Her father said they cost about $4,000 -- something he can't come close to affording on his pay -- but that his health insurance has picked up the bill with no problems.
Last summer, after her father said she'd been wearing her current prosthetic for a year, Mithara outgrew her current prosthetic. When that happens, there's a negative impact: "It hurts," she said.
When Mithara is forced to walk out of alignment, there is more to worry about than the pain, Charles said. It puts pressure on her right hip, which has already undergone major surgery in the past as a result. At school, it also keeps Mithara out of one of P.E., one of her favorite classes.
On Aug. 8, Mithara's orthopedist prescribed her a new one and Charles said on that same day she fitted for it at Falk Prosthetics in Delray Beach. But weeks passed, then months, and there was no new prosthetic. Today, more than six months of needless suffering later, Mithara is still dealing with the old prosthetic that she's outgrown.
"She can't wait," her desperate father said. "Her hips can't wait."
Falk orthotist Jeffrey Price said his firm promptly contacted Mithara's insurance company, UnitedHealthcare, about the claim, but despite the doctor’s order, it wasn't immediately approved. The insurance company, according to Price, said Mithara was allowed only one every three years.
Price said that days later, his firm pressed the matter with the insurance company, speaking with a United supervisor about the matter. At that time, according to Price, United said they would allow it but only if medical proof was shown that Mithara had grown. Price said that requirement led to a 10-week delay, but he did not explain what caused the additional of wait of nearly four months.
Attorney Jay Cohen, an expert in cases of delayed medical care, said that while it may seem absurd for an insurance company to demand proof that a 9-year-old girl had grown for a year, such red tape isn't uncommon.
"It's uncalled for. It's unnecessary," Cohen said. "It's unfair that she had to go through additional pain and discomfort. If her doctors prescribed the prosthetic, they knew that it was needed then and there."
Charles, who is now studying to become a nurse at the age of 51, puts the blame on UnitedHealthcare.
"Every day is a struggle," he said.
Good news came shortly after the Local 10 News interview with the father and daughter -- the prosthetic leg was finally approved. Mithara has been refitted for the new prosthetic and expects to receive it any day and is looking forward to returning to P.E. class.
But getting answers from UnitedHealthcare on what caused the massive delay proved difficult. After several off-the-record phone conversations between spokespeople of the company and Local 10 News, the company provided a brief statement late Tuesday.
"We approved the new prosthetic for Mithara as soon as all of the clinical information was shared with us in January, as we have done with each previous request," the statement said. "If any member has a concern, we encourage them to call us right away so that we can help."
Charles Bateau, however, said there were no long delays in the past. While the statement indicates the prosthetic was approved in January, it wasn't officially approved until Feb. 17.
"Corporations should not be practicing medicine," Cohen said. "When you hear about a little girl like that who may have suffered an adverse consequence because of that kind of delay, I mean, that's horrific."
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