Friday, May 2, 2014

Deep Breaths

I have some good news. Jax got 10 'swallowing dysfunction' therapy sessions approved. I called the insurance company when I got the letter (stating our pediatrician got it approved) to make sure I was understanding that our current feeding therapist could do these sessions. The customer service rep then told me we only pay 30% of each session since our deductible has been met. Uh, say what? We've had this insurance less than 30 days and the deductible is $5k!
I did some digging and found out that Jax's hGH meds (3 month supply) has been applied and they're waiting for us to pay it. I didn't have the nicest phone call with this new mail-order pharmacy that we have to use, because I was stunned when she told me I had to pay it right there over the phone in order for them to release the drugs.
Uhhh, say what?
I asked her who just pays $5,000 over the phone like that? Her response, "A lot of people do". So I took down her name and politely excused myself from that conversation since my blood pressure was boiling!
I have a message into the manufacturer of the drug hoping to help in some way. I have NO idea how they'd be able to, but I assume they've dealt with this before.
Sure, we could take the $5k out of our savings, but man... with this big job change that just took place, we've been dipping into it and it would just be nice if they could even just break up the payment a little bit. I feel uncomfortable taking large amounts of money like that out while we're in a state of transition like this for the family. Ahhhh, always something. We'll figure it out, I'm sure.

I called for Jax's May-medical-supply order today and found out that none of his Pediasure that he consumes orally is covered anymore. It was considered a medical-need since he couldn't eat enough 'food'. We had a feeling that it wouldn't be covered anymore with the insurance change.
So, we're now buying it by the case-load. I ordered a 12 pack of some organic nutrition drink for kids online that's comparable in nutrition/calories, so I'm interested to see if Jax likes that. I hate how much Pediasure he consumes each day.. blech! There so much fake stuff in there, that it makes my skin crawl to give him SO much of it. So now that I have to physically go to the store and buy it, I've decided to look at alternatives.
He still has to drink about 3 Pediasures a day to keep up the amount of calories and nutrition he needs. We'd rather he drink it and we pay for it, rather than he take it through the tube and have it covered by insurance. Ce la vie.

We're still in a state of chaos lately around here. I can't wait for summer when we have help with the kids so Jay and I can both focus more on work. It's so close, but seems so far!

We took the kids to their kindergarten-preview-night where they got to see their new school while Jay and I attended a meeting in the gym. It's a very tiny school with only two kindergarten classes (connected to each other) which I really like. It's mainly the Town of Brookfield residents who are far from the other Waukesha schools. We found out the school is getting all new playground equipment this summer, so the boys really lucked out. We'll be back in August for their official open house and pictures. Jax can't stop talking about kindergarten, high school and college. HA, he's forgetting a few years in there!

Jax was back at feeding therapy today. His therapist had perfect timing with his two week vacation! Jax did well, and we discussed how he would document any and all progress Jax makes to resubmit to insurance for more sessions when we're close to the 10.

I took the boys to a field trip with their class today. They don't have class on Fridays, so they thought it was cool to see their friends. They saw the high school kids perform 'Alice in Wonderland'. They thought that was neat.The boys have a birthday party to go to tomorrow afternoon, so they're definitely having some fun lately!

I'm getting ready to go on my first work-trip in a week. I leave next Saturday for Toronto Canada, which is also Jay's birthday, boo! The next day is Mother's Day, uhhh, double boo :(
I'm excited for the trip because it will be an amazing experience for me to help run a conference of this size, but the 7-days-gone part makes me a bit itchy. I've had time to process it and am working on it. So, the next week will be non-stop work and preparation until I leave. I'll do my best to get another update in before I leave, especially since we have the boy's IEP meetings on Wed and Fri this next week!

Still loving their costumes!

I caught them spooning!

Jax saw that I saw them, so he gave Brady a BIG squeeze, AWE!

1 comment:

Michele said...

Insurance companies can be so difficult to work with. I've had a lot of struggles with ours, and we've ended up paying thousands out of pocket for necessary services that they don't cover. They always say it's "not up to them" because it's the plan our employer negotiated with the insurance company and so we should take it up with our employer... as though employees have any say in that!

A couple tips - you can deduct medical expenses above 10% of your income on your federal income taxes, and you can withdraw money from an IRA penalty-free if it is to pay medical expenses. Also, look into whether you can get a HSA or health flex account through either of your employers, that at least makes some of it tax-exempt. Covering the boys on two insurance plans if possible is totally the way to go, if you have the option of insurance through your new job. It may even be worth it to see what kind of a secondary policy you could get on the open market. The secondary plan would pick up the $5000 deductible and any co-pays that come up.

For the HGH, can you shop around to get a better price with a different pharmacy, or pay for it 1 month at a time? I love that you already contacted the manufacturer, that's a very good idea. And good luck with the grant!!