Showing posts with label Insurance. Show all posts
Showing posts with label Insurance. Show all posts

Thursday, July 8, 2010

No news is...



Good news. Right? Things have been going very well here. I realize how much I complain, I am much better about posting when I'm complaining or worrying - luckily there hasn't been much of either lately!

So here's a recap of the last three months (yes, three months, I am a slacker).

In March - X-Man's foot did heal. In only a week or two he was back to being himself, running and jumping. Now, because of daily stretching and weekly PT, he can even stand on his toes and squat for a few seconds (YAY!).

In April his flexibility continued to improve. He gained a few degrees of dorsiflexion on each foot. In April we also found out that my husband was offered a new job. Unfortunately, that meant that beginning on May 1, we no longer had health insurance for a month (unless we chose to have Cobra which cost more than our mortgage payment!). I talked to his therapist and she was kind enough to let us come every other week and shorten the sessions so that our self-pay bill (which, BTW costs $231/hour) would be greatly reduced.

In May we went to Iowa for a follow up appointment. Because of Ben's new job, he wasn't able to come; however, my sister S stepped up in a big way and traveled with the kids and I. Dr. Morcuende seemed very happy with X-Man's flexibility. Since our last visit, X-Man had gained about 5 degrees of flexibility in each foot. He said the main thing is to continue stretching and going to PT. Nurse Maria was on maternity leave (in February she didn't even look pregnant - lucky lady!), we missed her but still had a good visit.

Aunt S with Little Lou and X-Man

X-Man at THE Ponseti Clubfoot Clinic (we are so blessed!)


In June we took a much needed vacation. Little Lou and X-Man fell in love with the ocean. Our church also had VBS which was a lot of fun. On June 1, our new insurance benefits kicked in so we went back to weekly PT visits. His therapist also gave me some information on the local University's physical therapy department. Because of his clubfoot, the students would like to study him and learn more about how to treat other children with similar conditions. I'm thinking about going, I just have to figure out childcare for Little Lou.

We've been having a pretty great summer so far. Near our home is a pretty large reservoir with many steps and a ramp right next to the steps. About once a week we go and walk up the ramp two or three times to stretch his feet. By the way, in case you were curious, there are 123 steps - in the photo below, X-Man and Ben are about halfway down (or up).


I know this post was short and sweet, I'm hoping to post more throughout the summer, but no promises! At any rate, I continue to see how incredibly blessed we are and am so thankful to have the life that I do.

Wednesday, October 14, 2009

I loathe our insurance company, but I love God!

So, this morning starts off by a call from University of Iowa's financial office. The guy on the phone tells me that our insurance company has denied coverage for X-Man's castings (wow, I am so glad not to have his job!). He tells us we can become self-pay and gives me an estimate of how much all of his visits would cost us. Let me tell you, they were so generous with the amount that they will charge us - I was expecting charges much higher than what he told me. As a self-pay patient, we will have to pay $700 on Monday and then pay the rest as we go on with treatment.

After I put the kids down for naps, I called Anthem and asked if they could provide a reason that our coverage was denied. They tell me it's because people in Ohio do the Ponseti method (once again I explain that they do the method for babies, not for relapsed children). I ask what option I have, can I talk to someone else to get this taken care of? They tell me to call Dr. M and ask for three times that they can call him for a Doctor to Doctor consultation.
I call Dr. M's office and leave a message for his nurse, Maria (she, BTW is maybe the kindest person I've talked to in a while). She calls me back and says (paraphrased)
"I'm sorry that your insurance company is giving you so much trouble. I talked to Dr. Morcuende, and he said don't even worry about the insurance company. Come to your appointment on Monday, we will cover the costs..."
I can't breathe. I can't talk
"We have a fund set up for people in your situation. Of course we like to make money, but we want your son to be able to have treatment."
I tell her "You're going to make me cry... " I think I muttered some non-sense and then thanked her again, and again, and again.

How amazing is that?

I called Ben, I feel bad. There are so many people who are in much worse situations than us. He tells me "Michelle, this is God's hand at work". Wow, that Ben is so intuitive. We agree that we will pay back every cent so that someone else can have this amazing opportunity - it may take a year or so, but we'll do it.

I woke up this morning praying that God would have insurance cover our costs... God responded by giving us an amazing opportunity. Our X-Man gets to see the top Ponseti team in the world for treatment, and we only have to pay for our travel costs. Talk about answered prayers.

Thank you God... How could I ask for more?

Insurance - how I love and loathe you...

So, I thought I'd provide an update of today's calls and plans... This morning I received a call from a nurse in the precertification department of our insurance company, here's the jist of our conversation:
IN (as in, insurance nurse): Good, morning, this is _________ from Anthem.
Me: Oh, hi, how are you?
IN: Good, you?
Me: Good thanks.
IN: So, we called Nationwide Children's Hospital and they said that they do the Ponseti treatment
Me: Yes, they say that, however they are not a Ponseti approved provider
IN: Oh, I didn't realize that they had to be a Ponseti approved provider
Me: Yes. We were going to a doctor with Nationwide for treatment, but they won't recast children that relapse - they go straight to surgery. There is no one in the state of Ohio who will recast relapsed children.
IN: Oh. Well, you know this Dr. M may not be able to correct your son's feet with castings and he still may need surgery.
Me: Thanks for the negativity (okay, so I just thought this)
IN: I'm going to have to forward this to an M.D. for approval - they should have an answer in 24-48 hours

I'm hoping that we hear back tomorrow, if not, by Thursday.

So, then Nurse Maria at Dr. M's office called me (she is much nicer than Insurance Nurse). I tell her about the situation with our Insurance company. She says that Anthem normally isn't a problem but that if they (Anthem) aren't able to approve us for treatment, they (U of Iowa) can work out a payment plan and give us discounted rates. She assures me that we will figure this whole situation out. What a Godsend. So, we have decided to schedule six appointments between next Monday and December 7. I've been praying all day long that insurance will help us with the costs, but I'm so happy that regardless of what happens there, we can still go and X-Man can have treatment by perhaps the best Ponseti doctor in the Nation, maybe even the World.

I put in a room request at the Ronald McDonald house each Sunday before our Monday appointments. We won't know until each Sunday if we have a room because they give first priority to critical care families and families that are already staying in the house (families get to use their room for as long as they need it). It's a nine hour drive from Columbus, so we will need to leave each Sunday morning and we'll return Monday evenings. We're looking into churches with Saturday evening services so that we can have some sort of worship schedule.

Today, we also went to half-price books (I LOVE that place!) and picked up some books. We're going to give X-Man a new book at each Doctor visit in hopes that he'll stay still during casting. X-Man knows that we are going far away to see a doctor so that he can get casts on; we've been looking at lots of pictures of kids in clubfoot casts. I've also explained that he won't be able to walk with his casts, I don't know that he really understands that part. It'll be tough, but we'd take this over another surgery any day!

So, I would never wish this on any one, but there are definitely some huge blessings coming out of this situation already:
1 - I am realizing how truly blessed I am to have two healthy kids.
2 - My relationship with God has gotten so much stronger over the past couple of weeks. I've been praying more, reading more, and fasting more. And in all this, I'm not worried. I know that everything will work out for our little guy. I'm frustrated that we have to travel 1000 miles each week and that insurance is being difficult, but I know it will be okay.
3 - Ben and I are doing really well. We aren't arguing about silly things and our relationship is much stronger.
4 - I am calming down. I'm not worried about the dishes in the sink - they'll get done. I'm concerned with my family and not the chores and everyday things.

One more thing. This morning when the kids were eating breakfast, I read them Proverbs 13 (since today is the 13th). X-Man asked me to read chapter 15, there was so much that jumped out at me today. Here's two verses that seemed especially appropriate:
Pro 15:13 - A happy heart makes the face cheerful, but heartache crushes the spirit.
Pro 15: 30 - A cheerful look brings joy to the heart, and good news gives health to the bones.

I can't control this situation with the insurance company, but I can control my attitude. And that's what I shall do.