Inspired by Tyler Perry's Madea, mom fights -- and wins -- health insurance battle

An Iowa mom drew inspiration from filmmaker Tyler Perry's character Madea as she battled to get an insurance company ...

Posted: Apr 3, 2018 12:56 PM
Updated: Apr 3, 2018 12:56 PM

An Iowa mom drew inspiration from filmmaker Tyler Perry's character Madea as she battled to get an insurance company to cover her son's open-heart surgery.

Madea is the no-nonsense, ultraprotective matriarch in Perry's blockbuster movies.

Boone Begner's cardiologist recommended open-heart surgery out of state

His mother says she called the insurance company for months to get approval

When she was hung up on, she says, she channeled Tyler Perry's Madea

Lisa Begner's 5-year-old son, Boone, was born with three chambers in his heart instead of four. In early November, his cardiologist advised open-heart surgery at Children's Hospital of Wisconsin.

Begner called her insurance company to make arrangements.

In mid-March, after nearly five months of calls, she'd had enough.

Frustrated with a customer service representative, Begner, a registered nurse, asked to speak to her manager. She said the representative then hung up on her.

Begner, a fan of Perry's films, says she thought: What would Madea do?

"I thought, 'Mama Madea would say, "Uh uh! You ain't talking to me like that!" ' " she said.

Begner says she knew that Madea would rain holy hell on the problem.

So she went to the top: That evening, she emailed the governor of Iowa, Kim Reynolds.

Begner received a call first thing the next morning from Reynolds' office. The staffer told Begner she'd be getting a call from her son's insurance company, Amerigroup.

The next week, Begner received a call from the company, saying Boone's procedure in Wisconsin had been approved. Her son had the surgery Thursday morning, and Begner says he is recovering well and expected to go home Tuesday.

"Our top priority throughout this process was to help the child receive access to the care he needed. Amerigroup communicated with the mother on numerous occasions to keep her updated on our efforts. As he recovers from surgery, our case managers will remain engaged and in contact with the family to ensure that the child continues to receive medical care and support services," company spokesman Tony Felts wrote in an email to CNN.

Felts added that "doctors did not indicate that surgery was necessary right away."

In the procedure, surgeons removed part of a slow-growing membrane in his heart that would at some point impede blood flow. Dr. Benjamin Reinking, Boone's cardiologist at the University of Iowa, said that although there was no particular date for doing the procedure, "it needed to get done."

Begner is relieved her son was able to have the procedure but questioned why it took so long to work it out.

"It's absolutely crazy that I had to go that far, that I had to get the governor involved," she said.

Thursday's surgery was the fifth for Boone. He had the other four before his 1st birthday.

"He's fought for his life so many times," Begner said.

The young boy's journey has been so perilous that when he started preschool in September, local media celebrated with stories about how he had beat the odds.

Begner said she had great admiration and respect for Madea because of the way she fights for her family.

"She doesn't back down. She lets people know that 'just because you're in a position of authority, you don't have a right to treat me disrespectfully,' " Begner said. "She's an advocate for her kids."

Just before her son was wheeled into surgery, she wrote in a text to CNN, "I will hand my child over to [the surgeons], I hope and pray our Lord gently guides his doctor's hands. I pray Boone has sweet dreams, and feels nothing but God's hands on his heart."

Like nearly 40% of all children in the United States, Boone has his health insurance through Medicaid. The state of Iowa contracts with Amerigroup to manage his policy.

His battle with Medicaid is not unusual.

Unlike Medicare, the health insurance program for the elderly, Medicaid programs are run individually by each state. That means getting surgery out of state often requires special permission, even when all parties agree that the patient would be better served by that out-of-state program.

Reinking recommended Children's Hospital of Wisconsin for several reasons.

First, Boone had his first heart surgery there as a baby, and so the surgeons there would be more familiar with the scarring from that procedure.

Second, they would be more familiar with Boone's unique anatomy. He was born with a rare and sometimes life-threatening birth defect called heterotaxy syndrome, so in addition to his three-chambered heart, his stomach, liver and other organs are in the wrong places, and he has eight spleens.

"Wisconsin is the most appropriate place for him to have his surgery," Reinking said.

Dr. Roger Mee, the former chief of pediatric surgery at the Cleveland Clinic, agrees.

"His first surgery he had as a baby was a big deal, and this second (heart) surgery is going to be even more dangerous," he said. "It's a complex situation, and it just makes common sense that it should be done by the surgeons who did the first one."

Mee also pointed out that studies show that larger, more experienced pediatric heart centers like the one in Wisconsin have better success rates with more complex surgeries than smaller programs.

Now retired, Mee said that while he practiced, he often saw families have to fight Medicaid programs to have specialized heart surgeries out of state.

"It makes me sad. They should put children first. That's the sign of a caring community," he said.

Aaron Kinney, executive director of the Herma Heart Institute at Children's Hospital of Wisconsin, said Iowa Medicaid wanted to pay the hospital less than what it would have paid a hospital in Iowa to do the same procedure.

Amerigroup spokesman Felts did not address that claim directly but said that "during the past few months, we have worked to arrange surgery for this child to be performed and covered in full."

Kinney said payment negotiations between hospitals and out-of-state Medicaid programs can be "very drawn-out," with weeks sometimes turning into months.

"This has got to be tremendously frustrating for families. I can see how they would say, 'Wait, this is partially funded by the federal government. Why can't my child be seen where my doctors are telling us to go?' " he said.

"I think we can do better for these patients," he added.

Frederick Isasi, executive director of Families USA, a health care advocacy group, agrees. He said families on Medicaid who need specialized care out of state often call his group for help.

"These families are working hard every day just to care for their children with special health care needs," he said. "Instead of helping them, we're making them spend hours and hours struggling with bureaucrats. That's the last thing we should be doing."

Indiana Coronavirus Cases

Data is updated nightly.

Cases: 996341

Reported Deaths: 16245
CountyCasesDeaths
Marion1343262101
Lake658231151
Allen57160791
Hamilton45963460
St. Joseph43954607
Elkhart35546503
Vanderburgh31975473
Tippecanoe27694256
Johnson24821440
Hendricks23647353
Porter22735362
Madison18538404
Clark18383248
Vigo17274300
Monroe15117197
LaPorte14987249
Delaware14931256
Howard14574286
Kosciusko12166147
Hancock11597175
Bartholomew11447179
Warrick11225188
Floyd10983214
Wayne10840248
Grant9898217
Morgan9361176
Boone8819115
Dubois8210129
Dearborn815492
Henry8107150
Noble7944106
Marshall7786134
Cass7462119
Lawrence7379168
Shelby7115114
Jackson691788
Gibson6480113
Harrison641591
Huntington630299
Knox6269105
DeKalb623796
Montgomery6184109
Miami586595
Putnam573477
Clinton567171
Whitley558055
Steuben550473
Wabash5250101
Jasper520475
Jefferson504695
Ripley492485
Adams472773
Daviess4596112
Scott433968
Greene421196
Wells419787
Clay418460
White414261
Decatur4118101
Fayette402186
Jennings383260
Posey374243
LaGrange352078
Washington352049
Randolph339999
Spencer336442
Fountain331858
Sullivan326652
Starke310868
Owen310169
Fulton304566
Orange290562
Jay278445
Perry264452
Franklin262742
Carroll258232
Rush257232
Vermillion254254
Parke229726
Pike227343
Tipton225659
Blackford187840
Pulaski181155
Crawford158122
Newton155648
Benton150117
Brown144047
Martin137319
Switzerland133911
Warren120116
Union106615
Ohio84012
Unassigned0532

Ohio Coronavirus Cases

Data is updated nightly.

Cases: 1490451

Reported Deaths: 23327
CountyCasesDeaths
Franklin1620041662
Cuyahoga1439412412
Hamilton1040301409
Montgomery727961240
Summit606541094
Lucas55296904
Butler50803707
Stark456401053
Lorain34875568
Warren32293369
Mahoning30057672
Clermont27811321
Lake26457434
Delaware23872162
Licking23361283
Trumbull22357552
Fairfield22081241
Greene21967311
Medina21624305
Clark19513349
Richland18225280
Portage17579247
Wood17122220
Allen15627269
Miami15259296
Muskingum14417174
Columbiana13587263
Wayne13494263
Tuscarawas12372298
Marion11742175
Scioto11313154
Pickaway11246141
Erie10586180
Ross10397196
Lawrence9630137
Hancock9476149
Ashtabula9370197
Belmont9059197
Geauga8766157
Jefferson8439191
Huron8172139
Union806256
Washington7995137
Sandusky7654145
Athens765372
Knox7539138
Darke7525151
Seneca7166144
Ashland6761125
Auglaize663396
Shelby6374111
Brown626282
Crawford6147130
Mercer605793
Defiance6043102
Fulton588596
Highland585899
Madison584976
Clinton573890
Logan566292
Guernsey564867
Preble5623121
Putnam5227108
Williams515384
Perry510661
Champaign500871
Jackson493470
Ottawa476686
Coshocton466382
Morrow448256
Pike428462
Fayette419960
Adams409287
Gallia408165
Hardin407176
Van Wert361578
Henry356671
Holmes3539122
Hocking349078
Wyandot315761
Carroll294559
Paulding274345
Meigs256849
Monroe210553
Noble195146
Morgan188132
Harrison177042
Vinton161124
Unassigned05
Fort Wayne
Mostly Cloudy
55° wxIcon
Hi: 57° Lo: 49°
Feels Like: 55°
Angola
Cloudy
55° wxIcon
Hi: 54° Lo: 50°
Feels Like: 55°
Huntington
Partly Cloudy
55° wxIcon
Hi: 57° Lo: 47°
Feels Like: 55°
Decatur
Partly Cloudy
55° wxIcon
Hi: 57° Lo: 50°
Feels Like: 55°
Van Wert
Partly Cloudy
56° wxIcon
Hi: 57° Lo: 51°
Feels Like: 56°
It’s a cool Saturday with drier conditions and low humidity levels.
WFFT Radar
WFFT Temperatures
WFFT National

Community Events