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HMO Denies Treatment, Skinless Girl Has No Remedy

Francesca Tenconi, 11 - Oakland, CA
According to father Donald Tenconi:

Eleven year old Francesca Tenconi suffers from Pemphigus Foliaceous, an auto-immune disease in which the body's immune system becomes over active and attacks the protein which adheres the top layer of skin to the body. Francesca's parents had to battle with their HMO to insist upon appropriate diagnosis and medical care.

Francesca's medical and insurance ordeal began in December 1995, when at the age of 11, she developed what was diagnosed as a skin rash. By March, the condition had spread and become worse. By late April, the condition was so bad she could not attend school. During this period, several requests were made for referral to specialists outside the HMO. These requests were denied.

Finally, on May 8, 1996 (almost 6 months after the first appearance of symptoms), the HMO sent biopsies to out-of-network doctors and finally obtained an accurate diagnosis. The diagnosis was Pemphigus Foliaceous. Even after receiving the diagnosis, the Tenconi's HMO still insisted on treating the disease primarily with its own doctors. It was not until February 1997, over one year after the symptoms first appeared, that the HMO finally agreed to allow Francesca to receive care at Stanford Medical Center, which possessed the doctors capable of providing the best care available in the San Francisco Bay Area.

Explaining the prolonged and unnecessary pain of lying down without skin on your back for over one year, Donald said "If you feel this pain you will shed tears of pain, the same pain that Francesca shed night after night, week after week, for many months."

Because Francesca received her health care through Donald's employer, the HMO claims that ERISA shields it from damages for delaying and denying medically appropriate treatment.

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