A bright and resilient young girl lives with Williams Syndrome — a rare genetic condition that affects multiple systems of the body, including the heart. Since infancy, she has faced complex congenital heart disease requiring multiple procedures. When her condition progressed, her doctors determined she needed a pulmonary artery reconstruction — an extremely rare surgery.
For years, her mother battled through a maze of rejections, referrals, and red tape under legacy insurance plans. State programs denied assistance. Several leading children’s hospitals declined to perform the surgery because of how deep in the lungs the defect was located.
When the mother’s employer switched to Sidecar Health, everything changed.
Real support without red tape
Even before the family’s new plan took effect, Sidecar Health’s Care Partner team reached out — learning the details of the case, coordinating with providers, and ensuring a seamless transition of coverage. Their role wasn’t to direct care but to empower the family with knowledge, guidance, and reassurance.
As the family and their doctors contacted top children’s hospitals across the country, Sidecar Health stood behind them — ensuring coverage would never stand in the way of care. The Care Partner team equipped them with the right information and confidence to pursue every opportunity, providing real support without red tape.
A complex heart surgery, fully covered
When a leading surgeon agreed to take the case, Sidecar Health stepped in to ensure every detail of coverage was in place before the procedure began.
Sidecar Health plans are built around Benefit Amounts — the amount the plan pays for any given care, based on average local costs in each market. Members can choose where to receive care and how to spend those dollars: if the cost comes in lower, they keep half the savings; if it’s higher, they simply pay the difference.
For a procedure as rare and specialized as this one, the “average cost” reflected the reality that only a single surgeon in the country could perform it. In this case, that meant a $4 million surgery — and Sidecar Health covered it in full.
The member’s plan carried a $0 deductible, so the family owed nothing out-of-pocket. No balance due. No coinsurance. No surprise bills. Just the freedom to focus on what mattered most: getting their child the care she needed.
After a nearly 18-hour procedure, the surgery was a success. Today, the young girl is home, recovering, and thriving — a powerful testament to how Sidecar Health makes extraordinary care possible.
Coverage that goes beyond the bill
For this family, Sidecar Health didn’t just cover a bill — it changed what was possible. After years of obstacles and uncertainty, they finally had a partner who stood with them through every decision, every form, and every moment of fear.
Because the procedure was fully covered, they never to think twice about pursuing the best care — even when the cost reached $4 million. They could focus on their child’s recovery, not the financial fallout.
That peace of mind is what Sidecar Health delivers — coverage that truly works when it matters most.
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