• Sun, Dec 29 - 10:08 am ET

Alexis Shapiro Is Literally Eating Herself To Death And Her Insurance Company Is Doing Nothing To Help

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I think this next story is a great reminder to all the sanctimommies to think long and hard before judging anyone. Alexis Shapiro is 12-years old and is average, height-wise – - four foot seven. But Alexis weights 200 pounds. But before you jump to conclusions and blame the parents, understand – What happened to Alexis is not her fault nor her parents. A few years ago, Alexis had a brain tumor removed. The procedure damaged her  hypothalmus and caused something called hypothalmic obesity, which is incredibly rare. The only treatment that will work to help her is gastric bypass surgery, but her parent’s insurance company won’t cover it.

According to reports, Alexis is being kept on a restricted diet, but nothing has stopped her from gaining weight. TRICARE, the family’s medical insurance company since her father is in the US military, has repeatedly denied all requests for a Roux-En-Y gastric bypass. The notice reads “Our reviewers have denied your request for Roux-En-Y Gastric Bypass.”

According to an interview with NBC news, Alexis has been steadily gaining two pounds a week. She’s been hospitalized for a kidney infection, and has already developed type 2 diabetes requiring insulin injections. Her doctor, Thomas Inge, believes that gastric bypass is the only solution:

“I think it is disappointing that they cannot see the facts of this case. There is no evidence that doing nothing would be in this child’s best interests. “

The hardest part of this story is reading about the extremes that Alexis’ family must go to in order to stop her from literally eating herself to death. Her father, Ian Shapiro is understandably worried:

“She’s always hungry. In the past, we’ve had to padlock the cupboard.”

TRICARE’s excuse for not covering the procedure needed is that gastric bypass isn’t covered until the patient reaches the age of 18 and/or has full bone growth. According to TRICARE spokesperson Austin Camacho:

“In general, our Managed Care Support Contractors are required to approve or deny coverage based on TRICARE policy. We have an appeals process in place specifically designed to give our medical professionals the opportunity to examine the details of any special cases when coverage is denied.”

Without insurance, the cost of the procedure is a whopping $50,000. The Unless TRICARE reversed their decision, the family’s options are limited. There have been other, similar cases in the past. Kelsie Blackwell, of Indiana successfully had gastric bypass surgery at 18 and lost 100 pounds after being given the same diagnosis as Alexis. The difference being that Kelsie’s insurance covered everything.

Alexis’ family have created a Gofundme account to cover her medical costs. I seriously wish them well. I think this is a perfect example of how messed up the medical industry is in the US. I hope things work out for Alexis, I really do.

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  • silly_world

    The good news is that they have raised over 52,000 dollars so far!I have much hope for this little girl and her family.

  • Kay_Sue

    You and your doctor should be the final say on what medical procedures you need and receive, not your insurance company. Disgusting.

    • Haradanohime

      That’s actually my beef with the ACA. It’s not actually getting you health CARE Just insurance. As I said in a previous reply, Insurance companies will do ANYTHING in their power not to pay out. Look at auto insurance. It’s been around for a while and they will do all they can not to pay out. Having mandatory medical Insurance doesn’t mean you won’t still pay out of pocket because some person behind a desk who usually isn’t a doctor/nurse/medical practioner of any kind, doesn’t know you, your situation, your medical history and risks, and what actually IS necessary. So like this poor young girl who actually does have insurance coverage and is in medical need of a procedure, yet they will deny deny deny. (off soapbox)

      PS I think universal health CARE is a wonderful Idea. just not universal health insurance.

  • Andrea

    And yet in the previous story, the girl’s family has insurance that will cover maintaining a corpse? That’s seriously fucked up.

  • arrow2010

    Geez, if the child is hungry feed her. Let her eat.

    • Haradanohime

      That’s not the point. Even if she has already eat the gland in her body that tells you you’ve had enough doesn’t work right. And her body is always getting the signal that she’s starving even when she isn’t.

    • SusannahJoy

      Seriously! I mean, it’s not like it’s the adults job to say what’s best for her. She’s a child! A human child! And she’s hungry! It doesn’t matter that really, she’s not hungry anymore and that it’s only a glitch in her brain that’s telling her that she is, the point is, we should all give kids whatever they want, right?

      Oh, no, not right. We actually are not supposed to let kids kill themselves. It’s ok though arrow, I always get that mixed up too.

  • EX

    But it doesn’t sound like this is over yet? I imagine the insurance company is likely to pay once it’s appealed – not out of the goodness of their hearts but because it is in their best financial interest. Not helping this girl now would cost them more in the long run.

    • Haradanohime

      But how long will the appeal process will take is problematic. She’s already to the point of being diabetic. It’s a fair assumption to make if something doesn’t happen soon she could die. Yes, they could use the donations toward her procedure, but then the insurance company can be like “see you didn’t need our money so no we’re not reimbursing you either.” Insurance companies will do anything to get out of paying for things.

    • Véronique Houde

      The point is that the appeal process can take up to a year, and considering that this young girl is gaining 2 pounds a week, has been hospitalized already because of health issues and has developed diabetes, the doctors are afraid that she might not be able to wait that long…

    • Andrea

      Honestly, why isn’t the doctor/hospital just doing the operation anyways? That’s even more fucked up..because at this point, it’s an emergency isn’t it? Or it should be.
      Man I hate the health care complex in this country.

    • SarahJesness

      The parents did an online fundraiser and got the money needed for the procedure.

    • Haradanohime

      I thought it was for medical expenses she already had not the bypass procedure.

  • KaeTay

    for those reading: http://www.gofundme.com/3onp2g

    she got above what was needed for her surgery thanks to those who donated

  • DaisyJupes

    Unless I missed something, if she’s on a restricted diet with padlocked cupboards, how will gastric bypass help? Doesn’t that prevent food intake which is what her family is already doing?

    • Justme

      “Gastric bypass surgery, which makes the stomach smaller and bypasses some of the small intestine, appears to have an effect on the part of the brain related to appetite and satiety, the sense of fullness.”

      From the original article link.

    • CleaK

      I work in an office that does weight loss surgeries. According to the doctors in my office there is evidence that changing the way food enters the digestive tract (not just the amount) can alter the metabolic reaction and cause weight loss. This is why the Roux-en-Y tends to have higher weight loss rates and generally better long term weight loss retention than the lap-band, which only restricts food intake.
      We have had young patients under the age of 18 get the procedure but it is exceptionally rare for insurance to cover. They have criteria that needs to be met (age or completion of bone growth, as well as BMI requirements are among them, often along some evaluations by a nutritionist or a psychologist.) If those criteria are not met, they are under no obligation to cover anything. What needs to happen is for her doctor to speak to the medical director about this case in what is called a Peer-to-Peer and it sounds like that has not yet been done. Also there will need to be clearance from the hospital as well. Ours will not allow weight loss surgery on anyone under the age of 13.

  • Sarah

    I’m confused. She has an issue in her brain that wont turn off her hunger….so she continues to eat and eat and eat even though she doesn’t need it.
    How is gastric bypass going to solve this? Just because your stomach is smaller doesn’t mean that it’s going to stop her from eating when the size of her stomach was not the issue before????

    • Véronique Houde

      If you read the article in the comments, it’s because it has been proven that the procedure has an effect on the area of the brain that controls satiety, which would help her know when she really is full. It would also make it so that it’s physically painful to eat too much, thus helping her regulate her hunger and giving her cues to know when to stop.

    • Rachelxoxo

      If the problem is her brain constantly telling her she’s hungry, sadly enough she will eat through the pain. Many people who get gastric bypass do lose a significant amount of weight, but then gain it back because they aren’t treating the cause, only the symptom. The problem is their mental need to eat regardless of the pain they feel in their stomach, because if they were listening to how their stomach felt they wouldn’t need the surgery in the first place. It’s very sad, but they are many cases of patients rupturing their stomach or popping the stitches and gaining all the weight back. I totally agree that something needs to be done. I hope they find a cure, it sounds like such a terrible situation to be in.

  • AugustW

    TRICARE = try and get care.

    THat said, I’m not sure what a gastric bypass could do that a severely restricted diet can’t do?

    • SarahJesness

      Apparently the gastric bypass would make it so she knows when she’s had enough to eat.

    • Kay_Sue

      Changing the actual digestive system, for some reason, has been shown to be effective in these cases. The article linked above actually references a really successful case where a young woman received the surgery and had amazing results, allowing her to live a wholly normal life after the procedure.

    • Gangle

      I would say that the family have tried a severely restricted diet. I cannot imagine what it would be like to have a little girl who always feels empty and hungry, no matter what she eats. It must be incredibly exhausting, frustrating and distressing for both the little girl and the family. If a gastric bypass helps her by making her feel like she is actually full when she eats, then I think the surgery is essential.

  • mary

    god bless you alexis.. keep your chin up sweetie

    • Humphrey Bugoy

      which chin?

    • mary

      you sir are a heartless jerk!!