Friday, October 19, 2012

Days That Beat Me Down

I'm documenting all this not so you can feel sorry for us, but just to understand. When your child has a complicated medical situation, you deal frequently with insurance shenanigans (I love the word "shenanigans"). People on a medical board who have never met or examined your child get to make decisions about whether the results from the examinations and tests from your child's own doctor merit coverage by their company. Most likely, their assessments are based more on an analysis of treatment vs. risk of not treating than on whether it's a sound course for medical treatment in the first place.

We are still waiting on the BiPAP machine that was deemed necessary from Dean's latest sleep study. I'm not exactly sure why the insurance company thinks that it's debatable that having 10 episodes an hour of not breathing is significant. News flash: the jury's out. You know, because a pediatric sleep doc would prescribe a BiPAP machine to a 3-year-old just for kicks. I know, I'm rolling my eyes too.

I absolutely do not have the energy to go through all the phone conversations I have had lately with the medical supply company (who has been moderately helpful) and the doctor's office (who has been horribly UNhelpful), but suffice it to say that our healthcare system is broken. I know, I knew that already too, but take this case as an illustration of what needs to be addressed in our country. I'm not making a political statement, per se, but the issue of healthcare in this upcoming election means more than almost anything else to our family right now.

We are praying that we will hear by next week that insurance will cover the BiPAP. If they do not, we will be paying a hefty amount out-of-pocket. Either way, we've already contacted the medical supply company to get this started on Monday, because even if insurance isn't ready, we are. Dean deserves to have treatment for his medical necessities, and we'll fight like hell if we need to. Well, we already are. Dive back into the waves....

4 comments:

Candice said...

Oh Ali, I feel for you guys...

Giulia said...

Ali, my two cents. Don't deal with your insurance by telephone, but by written. You may had heard it enough to last a lifetime, but we never say it enough.

Also, don't be afraid of joining studies published in peer-reviewed journals. At least, you show them that you know your stuff and even better than them, so you make yourself respected.

Now, stop with the phone, because you spend useless energy for nothing. You take your red cape, pen or computer, paper, and you deal everything in writing.
Nothing by oral, they can easily trap you with promises not kept. And you'll be able to document if something gets wrong by written.

At most, contact the PWS Association. They can be helpful on these matters.


Take care

Ali Foley Shenk said...

Giulia,
I've mostly been conversing with the doctor's office and the medical supply company rather than the insurance company. The hang-up with insurance is through Medicaid, because Dean has a disability based form of it. They won't speak directly with the consumer about a claim. Hence the phone calls! It's crazy.
Ali :)

Giulia said...

Ali, Medicaid, insurance, supply company... whatever you want, the basic advice I can give you is : deal with it by written.

Like that, you can prove what you say. You make those people understand that you say what you mean and mean what you say.
They will think twice before fooling you next time.