It's like a soap box derby around here. I'm pulling out my soap box left and right and jumping on and saying what I need to say to anyone who will listen. Thank you Marcus, mom, dad and Marci:)
Remember On Monday I was going to call the orthotics place and insurance? Well, have no fear I did and we may or may not be going over our minutes for yet another month. Maybe I can bill those to insurance?
First call was to orthotics who was surprised when I said we received a letter as they had yet to get one. Next she was surprised on their reasoning and agreed it was lame (yeah I got my soap box back out for her too). Next step is to appeal it and throw so much information their way that they cave and agree to cover it.
Second call was to insurance this was call probably wasn't necessary but hey I thought maybe I can ask for an exchange on their decision in my head it went something like this after I dialed 1 and verified my identity:
I(insurance): how may I assist you today
me: yes, I would like to exchange your lame excuse letter for not covering my son's durable device for an approved coverage letter please (this is where I would get out my soap box)
I: well of course mam, we are sorry that you aren't satisfied with that, our goal here is to make sure everyone is happy and cared for in the best way possible. We do apologize for the error we made in making our decision. Let me just go into the system and get that changed for you.
me: "smiling ear to ear" thank you
WAKE UP!!!
Yeah, it went nothing like that at all (It really hurt my exchange/return record). Instead after she pulled up our records and I pulled out my soap box,I think she put me on speaker then muted the phone and went for a coffee refill, potty break, water cooler catch up session (where they probably talked about me and what they were having for dinner) and came back to say "mam, that is all not to true there are some procedures that are guaranteed and those who reviewed the case felt this was not one of them and when you appeal it you are more than welcome to include everything you said into a letter." As I defeatedly got down from my soap box and was pissed beyond pissed I did what any female would do (no matter how sensitive you are)....CRY!!!
I talked to Marcus as I was trying to figure out why I'm so pissed at their decision when all along I knew the chances they wouldn't cover it were very high so I shouldn't be surprised by their response. What I wasn't prepared for was their choice of words. You can bet we aren't going down without a fight. As I said before Ian will get what he needs with or without the help from insurance (obviously it would be great for insurance to help).
Insurance is a bitch! My insurance company was going to make us jump through hoops to try and get them to pay for Carter's plastic surgeon visits. They wanted pictures of his head, notes from the physical therapist, notes from the pedetrician, and all kinds of other stuff. But they still said the chances of them paying for it were 5%, so I weighed my options and decided not to fight it. It wasn't worth the stomach aches and stress. I have yet to meet anyone that has had their insurance pay for any of the helmet stuff. Luckily my insurance did pay for most of the CAT scan on his head. They probably didn't realize what it was for and just let it slide. We have now paid for it all and can just sit back and let the baby's head round out in peace. Hey, you can look at it this way...it's one really expensive peace of mind. Peace of mind that your son's head will be shaped properly and peace of mind that you don't have to constantly worry about him bonking his head on hard surfaces.
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