I recently learned about a mom of three, Brandy from Not So Average Mama, who is desperate to see a neurologist. She's been experiencing scary symptoms—stuttering, head jerks, pain—and cannot visit a doctor because she and her husband are self-employed with no medical coverage. Brandy's entered a slideshow of hers in an Intel contest where the winner gets $5000; here's the place where you can vote.
I get distressed when I hear these kinds of stories; our country sure can make it hell-ish to get insurance coverage, and I'm eager to see what happens with health care reform in the upcoming months. I feel lucky that we have good insurance. I'm also glad that I have a big mouth when it comes to getting things for Max, as it's come in handy for fighting the insurance company to pay for his therapies. I ended up in a deadlock with them over occupational therapy, but they finally gave in on speech. Here's my victory post, along with some tips on dealing with stubborn insurance companies (I guess that would be all insurance companies these days). Oh and can I just say, our co-pay has risen astronomically in the last couple of years?
What sort of experiences have you guys been having with insurance companies lately?
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Hubby is actually going into the reserves because we are paying SO MUCH for health insurance and he works for a small company and Charlies' disability will affect the costs of everyone who workds there.
ReplyDeleteWe're fortunate to have what I think is very good insurance, but I did spend 20 minutes on the phone yesterday trying to explain that the Stander we need for our 18 month old is medically necessary to hopefully prevent the need for surgeries in the future. we'll see how far that got me within 30 days!
ReplyDeleteThank you so much :)
ReplyDeleteAutism gets NO insurance coverage here in Michigan (or most other states). NONE of my bird's therapies are covered.
ReplyDeleteI've tried to get her a CP dx since she has remarkable hypotonia, which affects all areas of her development and was the original reason for her dx of global developmental delay. She had to be resuscitated at birth (hellooooo). But, her MRIs show no hypoxia and the 3 neurologists she's seen rule out CP because she's not spastic. If this was 1985, someone would give her hypotonic CP... and we'd get a little help from the insurance companies. I'm THIS CLOSE to gathering birth records and really fighting. I just need to get the energy first, because as you know, ALL my energy is going to the day to day living...
I finally just won the fight for my daughter's eye doctor to be covered. My daughter just had her third eye muscle surgery, which was her fifth eye surgery all together, and they were refusing to cover that doctor because my daughter wasn't "severe" enough.
ReplyDeleteJust one of many battles that we have had. It is so tiring to have to fight for everything.
I may be the only one up here who can't really complain. In SC, we have TEFRA waiver for kids who have disabilities and don't qualify for regular Medicaid. Meaning they qualify based on disability and the child's income.(sorry faith, you had to quit you day job to qualify!)They cover most of everything we need except Faith's compounded meds. We have had to fight to be seen out of state for several things...DUKE....MARCUS INSTITUTE in ATL. That took A LOT of fighting but I did get it approved in the end and as a matter of fact I still get calls from those places asking for assistance in dealing with Medicaid in SC for families here. Kind of makes me proud! LOL! I know changes are eminent and heading our way quickly so I am scared. There are rumors of SC Medicaid cutting access to all therapies...period! So we will see!
ReplyDeleteI am cautiously optimistic about our insurance. We have it through hubby's job or we would be able to afford anything at at:( Be you never really know how good (or bad) your particular policy is until you start to exercise it- and so far, I am happy with it:) Eventually I will need to look into medicaid/medicare for Little Man & that is what scares me! I realize that healthcare needs work, but please, washington, don't mess with my health insurance, I like it just fine:)
ReplyDeleteWe have been fortunate so far with our insurance and I work for a hospital and it seems our premiums are much lower than most places. We just applied for TEFFRA also here in Oklahoma and expect we will be approved shortly. That will cover all our insurance will not. The only problem I had was earlier before Anna had her G tube and they would not cover the Elecare formula she was on and it was about $50/can. Our total out of pocket is only about $2000/person so we meet it pretty quickly with Anna and then they cover her at 100%. I feel so blessed to have all of this!
ReplyDeleteSelf-employed, it's health insurance or a house. The house won. Voted for Not So Average Mama, she needs to win.
ReplyDeleteI have so many memories of my mom on the phone for hours with them. I swear, everyone who works at insurance companies is dense...half the time, they don't even listen to what you're saying!! :(
ReplyDeleteA few weeks ago my insurance company approved for Luke to have his dental teeth cleaned, full xrays, a few teeth pulled at the hospital w/ anethesia! The dentist's office dealt with everything (I need to get a copy of the letter!) I know they used his cleft lip/palate and autism for justification. My insurance does a great job of covering in-network (never a question about 9 sets of PE tubes in 5 years!). But all of his autism therapy is out of network.
ReplyDeleteWe've been battling with our insurance company from day one; it's par for the course now that they are going to deny half of what Gabe's drs say we need and I will spend hours on the phone until it's taken care of. Fortunately, I stay at home and have the time to do it. In November it was suggested that Gabe be tested for ADHD, after fighting with the insurance company for months, they finally approved the testing; the dr wanted to know how I did it because apparently the company we work with (I'll keep it to myself to protect the idiots insurance company) is notorious for NOT covering ADHD testing. I guess the "You'll cover this or I'll call you every single day making your life a sheer hell until you DO cover it" threat worked.
ReplyDeleteI feel very fortunate for our coverage through my husband's military career. The cost of Isaiah's therapies, specialists, equipment, medications, etc...easily add up.
ReplyDeleteDitto on the military for me. In our case, Connor has now racked up over 1,300,000 dollars worth of medical bills, and Jeremy was airlifted six times and had seven (or was it eight? I can't even remember any more) surgeries so he's probably catching up to Connor fast. We've paid a grand total of forty dollars, which was for my food in the hospital when I had Connor.
ReplyDeleteI have absolutely no idea how civilian families do it, to tell you the truth. We'd be so far in debt now that we'd never dig ourselves out, even if all we had was a copay. Reminds me of just how lucky we are.
~Jess