LUBBOCK, Texas (KCBD) – A Lubbock family faced a $330,000 bill after their insurance company approved their 6-year-old son’s surgery, then refused to pay for it at in-network rates.
Paxton Kuitu was born with Microtia and Atresia, a rare condition that affects hearing and ear development. His parents, Valerie and Stephen Kuitu, spent nearly a year appealing insurance denials before the bill dropped to $2,000.
The diagnosis
On the day of his birth, Paxton’s parents and Dallas-area hospital staff were stunned to see that he had a small right ear and no ear canal.
“Nobody in the hospital where he was born at knew what it was called. Kind of that freak-out moment,” Val Kuitu said.
A month later, a plastic surgeon diagnosed Paxton with Microtia and Atresia. Tests confirmed he was nearly deaf in his right ear. He was fitted for his first hearing aid at 6 months.
The Kuitus saw specialist after specialist while making the move to Lubbock. They came across Dr. Sheryl Lewin, a California-based pediatric craniofacial surgeon who only operates on Microtia patients.
“It’s quite a rare disease. It can be one in 8,000 worldwide, and in certain populations, more rare,” Lewin said.
Lewin developed her own surgery technique that can create a symmetrical ear and implant a hearing aid in a single, outpatient procedure.
The insurance battle
By the time Paxton was 5, the Kuitus had a surgery date: June 2025. The Kuitus wanted Aetna to approve in-network coverage because there was no in-network provider who could do the same surgery.
“In March, we got the phone call that Aetna denied the in-network coverage. They did clear us for medical necessity, which is huge,” Valerie Kuitu said.
The appeals and denials continued. In June 2025, the Kuitus moved forward without a deal. Paxton had the surgery. The bill arrived: $330,000.
“I think we are probably going to be paying this off for the rest of our lives, and we are going to have to be okay with that,” Valerie Kuitu said.
The Kuitus worked with a law firm out of New York that had handled similar cases. The firm recommended that the Kuitus contact House Speaker Dustin Burrows’ office. His office contacted the insurance company directly.
“Representative Burrows’ office was able to help get us to the point where Aetna was willing to grant Dr. Lewin as in-network coverage, which is a big deal to give us the gap exception,” Stephen Kuitu said.
A network gap exception is a formal agreement where a health insurer allows a patient to see an out-of-network provider at in-network rates. Stephen Kuitu said that while Aetna granted the gap exception, the company didn’t sign the letter of agreement, which would finalize the deal.
The law firm suggested contacting a local news station. Valerie contacted the KCBD Investigates Team.
The resolution
KCBD took the complaints to Aetna’s parent company, CVS Health. The company researched the issue, then said the claims had been reprocessed. Paxton’s surgery was covered at in-network rates.
CVS Health sent a statement that reads, “Coverage for the ear reconstruction was approved and paid at the higher benefit level, and the issue has been resolved. Because no in-network specialists were available, the out-of-network provider was covered at in-network rates. One billing code was initially submitted in error and denied because that procedure was not performed. An administrative review confirmed coverage for the remaining services. We recognize how important this procedure is for the Kuitu family and continue to work closely with them and their provider to support access to care.”
When the final bill arrived, the Kuitu family owed $2,000.
“The fact that it’s only $2,000 is mind-boggling, honestly. It’s a blessing,” Valerie Kuitu said.
“It is heartening to know the Kuitu family was able to secure the coverage their son needed and that he is now on the road to recovery,” said Speaker Dustin Burrows. “I am grateful they reached out to my office. Supporting families in moments like these is central to our work as state representatives, and we remain committed to helping connect our communities with the services and resources they need.”
To contact your state representative, start here.
The Kuitus had help most families don’t have: a law firm, a legislator, and a news station. The right to appeal an insurance denial belongs to every patient. Insurance denials for out-of-network specialists are common, especially for rare conditions with no in-network equivalent.
The Texas Department of Insurance handles consumer complaints. The Kuitus say their message is simple: don’t stop appealing and don’t fight alone.
Click here to file a complaint.
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