Sunday, April 20, 2014

Insurance Woes

Happy Easter everyone!
We had a beautiful day of weather (finally) so it was nice to get outside a bit. Some of Jason's family came down for an early dinner. The boys really seemed to enjoy the day.

We've had another busy week leading up to the weekend. Jason and I took turns working late, but were both able to get a decent amount of things done around the house on Friday and Saturday. Jason even got the boys to the zoo on Saturday to see the Easter Bunny and to have a nice day outside for a bit.
I was trying to finalize Brady's summer speech therapy with talking with the new potential therapist. She prompted me to call our new insurance to get a better idea of what our out-of-pocket expenses might be.
I was so shocked during the phone call to the new insurance company. I was told that they will not provide ANY speech therapy to Brady, even with his Verbal Apraxia diagnosis. They said they only provide therapy to children who have had typical speech and lost it due to illness or accident and can be rehabilitated. I felt my face go red and my eyes start to well up.
I asked the woman to please check on Jax's feeding therapy submission that was sent in last week. Sure enough. Denied.
The woman on the phone said they don't provide ANY therapy to children with a tube-dependence, since there is no proof that clinics or therapy work.
I cried.
And cried.
And could barely get out any words.
The woman felt so bad and I could tell she was at a loss for words. I just wanted the phone call to end. She asked if we could get any supplemental Medicaid or anything, which made me even more upset with me saying "he just lost it this week".
Not my finest moment. Or the many hours after that I spent crying while trying to get things done around the house. It just seems so WRONG that an insurance company can just make these rules. They're telling me that they won't waste their money on things that can't be fixed.

After I calmed down, Jason and I discussed the exact situation. Brady only needs 3 months of therapy between the school years. He can't go without it since he loses any progress, and he really could use a boost with this particular specialist before kindergarten. I found a grant for kids with Apraxia that I'm going to try to get to help with the cost ($360/wk). The deadline is in a week and I have A LOT of paperwork and reports to get from the current therapist, a referral to the summer therapist, her invoice, the insurance denial, official Dx's from specific certified doctors, etc etc etc. So I'll be working hard to get this all together ASAP and cross our fingers. There's no guarantee that we'll get it since we're not low income, but, it feels like you need to be independently wealthy to afford all this stuff.

As for Jax... he can't stop feeding therapy. He just can't. It's about $400-$500/mo for him, and we've decided to just pay that and go without some other things. I'll call his feeding team at the hospital and see if they have any other ideas since I'm sure they deal with this from time-to-time.

His Occupational Therapist at the hospital gave him his last OT session the last day of his Medicaid coverage and gave me tons of tips for things to do at home. She feels confident that his remaining delays will be covered at school now. So here's to hoping Jax's IEP meeting for kindergarten next month includes some decent OT coverage.

The boys go back to school on Tuesday, which they are really ready for. Brady's cold is still hanging around, but we've been lucky that it's stayed contained to only him. I feel bad that he has a cold, but he's doing pretty well with it.
Jax ate his first m&m today. He decided at bedtime he wanted to bite the ears off a tiny chocolate bunny, and he did! He went to bed professing his love for chocolate and that he wants it for breakfast.
Looks like we'll be eating chocolate for breakfast. Not a bad way to start Monday...

Transformers from Nana Jayne!

Dying some eggs.

Bubba is living the dream.

So happy!

This is just funny.

My dapper Easter dudes. They were in Brewer t-shirts 5 minutes later playing in the yard.

Father Dick, Jason's parents and aunt/uncle/cousins.


Matt & Shana said...

sorry about the insurance! there are really no words for how frustrating things like that can be! but I'm glad you had a Happy Easter :)

Modesto Culbertson said...

Filing for insurance can be frustrating, and I'm so sorry to hear that you had to go through all that trouble. However, I'm sure your family will get through that obstacle. After all, you and Jason make a great team. Anyway, I hope Jax has been feeling well these days. Thanks for sharing that, Annie! All the best to your lovely family! :)

Modesto Culbertson @ D&Z Law Group

Joshua Duncan said...

You have a lovely family! Stay strong! I know insurance companies can be an absolute hassle. I have been going back and forth with my own insurance company for my son's speech therapy. He is only two and doesn't have a real diagnosis yet so getting them to help out with any payments has been a nightmare. Just be strong, you'll get through it!

Joshua Duncan @ Focus Insurance Atlanta