Wednesday, September 30, 2009

We Have Been Approved!

September 29, 2009

Anthem Blue Cross

Preauthorization Department

Fax: 1-888-656-5721

RE: Benjamin Garrett

Dear Blue Cross Anthem Preauthorization Department:

I am writing to you in regards to a request submitted by Dr. Charles Mace and Dr. Douglas McNeal for Benjamin Garrett to receive services at St. John’s Hospital with Dr. Sami Khoshyomn. Anthem Blue Cross has denied coverage because St. John’s Hospital is out of my HMO network.

Dr. Mace performed Benjamin’s first brain surgery at Cox Hospital when Ben was fourteen weeks old. However, Benjamin’s skull has closed again and he requires an additional surgery. Dr. Mace is not a pediatric neurosurgeon, and because second surgeries are so uncommon, we have sought treatment with a pediatric neurosurgeon.

Dr. Khoshyomn is the only pediatric neurosurgeon in the region. Over the past two and a half years, Dr. Khoshyomn has performed over forty surgeries in children who also have craniosynostosis, Benjamin’s condition. His method involves inserting absorbable plates and screws to keep the bones apart, followed by three to sixth months in a molding helmet. Dr. Khoshyomn has had such positive results with this method, that no children have required a second surgery. Cox does not have a pediatric neurosurgeon on staff.

Benjamin needs this surgery soon. If we wait beyond his first year of life, his bones will not be able to regenerate and fill the void created by the needed surgery and he will need artificial bone grafts implanted later, as a young child. This surgery is necessary for Benjamin’s skull to open to provide adequate brain growth, in order to prevent the possibility of seizures, blindness, and major developmental delays.

Additionally, Benjamin is facing living with a physical deformity and I truly believe it is too much to ask of him that he simply live his life with this deformity and its complications when there is a proven medical procedure available to correct it.

For these reasons, we are seeking Blue Cross Anthem to make an exception in Benjamin’s coverage, to include surgery performed by Dr. Khoshyamn and all of the associated hospital and medical expenses through St. John’s Hospital in Springfield, Missouri. Should you need any additional information, feel free to contact us at XXX-XXX-XXXX. Thank you for your time and assistance in this matter.


Josh and Lara Garrett


A record of phone conversations between Mr. and Mrs. Garrett and Blue Cross Anthem representatives (5 pages).

A patient story of Dr. Khoshyomn's that explains the procedure he has also proposed for Benjamin. This article also covers the possible complications of Benjamin's condition if left untreated.

Copies of St. John's Pediactric Neurosurgery website and Dr. Khoshyomn's credentials.

A news story about Dr. Khoshyomn and Dr. Shah's method of craniosynostosis surgery.

Referral letters from Dr. McNeal, Ben's pediatrician, and Dr. Mace, Ben's original surgeon.


That letter, those documents, and an extensive phone conversation between Dr. Sami Khoshyomn and Blue Cross Anthem were enough to persuade the insurance company to cover Benjamin's surgery and provide us with in-network level coverage. They are still denying coverage of the helmet due to its "experimental" nature, but in the big scheme of things, that's a minor issue. We are so relieved to have won our appeal and, as Josh said earlier today, now we just have to get through brain surgery. Our next appointment with the surgeon is scheduled for October 12th, and we will be setting a surgery date at that time.


  1. You will Love Dr. Sami! He is a blessing from God to any parent that has questions and concerns. He loves the babies he sees and makes you feel like you are in good hands. (by the way, my husband works with your mom and we have a son the same age as well) We had to see Dr. Sami for our little guys Torticollis. I do get updates from my husband on your sons progress, and will follow your blog to see how it goes. Please know you and your family are in our prayers!

  2. Hi Tiffany,
    My mom has told me about your great experiences with Dr. Sami and your sweet little boy. Dr. Sami is incredible. His wife talks to me every day at school now. They are the sweetest family. Thanks for the message!