Wednesday, January 23, 2008

Had a bad day

Sorry about not posting in a while but last week was a little overwhelming for me. Not only am I try to build myself up for Camis transitioning into preschool but we got a phone call from someone who we thought we would never hear from again. Who would that be you might ask? Well it would be a Medical supply company that we got Camerans Pediatric bed through last year. When I saw the caller I.D. I was thinking why in the world they would be calling me. This is when it got bad! Turns out they said they have been fighting our insurance for a year on approving the bed. Mind you they are calling me Jan. 17th the exact day last year that I got an approval from our insurance. Good feeling gone, jaw drop! She continues to say if you cant get your insurance to cove it we will have to bill you.....Are you ready......$5,345.00.....Yes you read right!

In the back of my mind I'm wondering why in the world she waited a year to call and tell me this and then also why in the world they would bring a bed to us let us keep it for a year and it had not been approved! Oh she says sometimes insurance say they approve stuff but they actually don't.......What? I'm now confused!

SO I hang up with her call my husband tell him the situation and he told me to call them back and tell them they can just come pick it up because he isn't paying $6,000.00 for a bed! Then he said no go ahead and call the insurance. So I get on the phone with them and they try to pretend ignorant to the whole situation. Asking me if I still have the approval number they gave me last year for the bed. I kindly said that was a year ago...Then a light came on and I asked them to wait one minute while I pulled out a notebook. Little did they know that I have always kept notebooks of Camerans use to be seizures that where dated with every day notes. Luckily there it was written Jan. 17th of last year and who I even spoke to! Imagine this they where like oh now I see it! Come on people give me a break here.
Well then the woman tells me well I see where we approved it and I also see where we denied it.....What? I didn't even know they could do that! She said we needed a letter of medical necessity which we did from our Neurologist the list just goes on! Anyhow she said they would have to send all this info off to another dept and it could take up to 30 days and to call back next week.
Well that night we decided to pull our claims up off the Internet and there it sat but there were only 2 claims found on the bed. Now remind you the woman I talked with from the Medical supply said they had been fighting them all year for an approval. Well let me tell you why she never called us any earlier and that's because the dates on these claims were for Dec of 07 yes just last month and then 1 filed Jan. 16th of this year the day before the company called me!!!! Sounds to me like our file got lost. Needless to say we have involved the city(Jason works for the city)and they are looking into it, she told us they cant approve something and then deny it..Just doesn't make sense! What a stressful week.

On top of all that drama, Cami will be starting S.N. Preschool in 2 weeks. This is going to be extremely hard on me. I have cried many times of thinking that she will be spending her days at school and not with me. It just doesn't seem fair sometimes, here I got to keep Caleb at home with me till he started K-garten and Cami just feels like she is being ripped from me. Typically when your child starts school you get to walk them in, spend a little time with them, drop by if you like to check in. Well at this school its the opposite! They want to cut it dry, no dropping in, Basically NO PARENTS ALLOWED! Is the way I feel, I understand that its probably better for the kids BUT its so hard on the parents not knowing what they are doing. Its a totally different feeling that I got with Caleb yeah I worry of the everyday dangers of school for him BUT with Cami different surroundings is a danger to her! We know she is safe here at home. I want this badly for her but I cant get that warm gooey feeling about it. Is it because she cant talk or communicate with me if something happens? Is it that I know that there is no way they can keep an eye on her at all times? Or is it that I feel like a failure because I cant do these things on my own with her. Why cant I teach her these things, why cant I be more firm with her! I already know the answer. I want her to be free to do what she wants I mean after all 2.5 years of her life she sat doped up on meds and still had seizures everyday. So I want her to be happy at all times I want her to explore! Whats more upsetting to me is that I know she is gonna cry why she is there because they are going to make her sit and learn more of a structured life. Which will be great but just knowing what she will go through to get there tears me to pieces and not being able to be there to comfort her. So yes I see why they try to push the parents out for that reason but I just wished they would give me one day with her to watch her routine! Reassuring me that it will be ok :(
We do have an Observation tomorrow morning with them so we will see how it goes! So please please keep us in your thoughts!


Kelly said...

Karen, we went through the SAME exact thing, pretty much word for word with Michaela's wheelchair (the price was even close!).

My advice would be to get a lawyer--perhaps a friend--who would be willing to lend their name to your vocabulary, and then flaunt it! Our situation went to collections, and I sent them a letter WITH the lawyer's name on it to show them I meant business. I called the insurance company often and recorded everything.

And really, when it came down to it, it was prayer that won the day. The insurance company called me to tell me that they would pay for it, and I just knew it was God.

So fight hard, and don't back down, and don't get discouraged--this happens all the time. It's a pain to deal with, but hopefully you won't have to go through it again after this!

JSmith5780 said...

I second everything Kelly says (Kelly it's great to see you posting). But more importantly I am glad you are "anal" like me and write EVERYTHING down. Finding it isn't always easy, but I know I write stuff down!!

As for the school issue. I completely feel your pain. I went through this with Connor. They wanted to start him in school at 19 months. There was NO WAY I wanted to put my baby (my peanut!) in school. BUT, I did... a month later.

It was THE BEST thing I ever did for him!!! Yes I can drop in, but they discourage it. The whole point is to get these kids into a routine, mom stopping by throws off the routine. Connor has flourished in this much so that he is close to losing his PDD-NOS diagnosis. I am elated and scared at the same time...will he still do well without all the support? I hope so. Next year will be interesting. He will most likely not qualify for ANY services. We will be on our own for a full year until he starts kindergarten.

My advice would be to ask if you can pass a notebook back and forth each day. We did this all last year. They put in a quick review of the day, his behavior, his mood, his successes, his failures. It allowed me to keep an eye on things even though I wasn't there.

Remember, she may not be "their" child, but theya re trained to find the best ways to work with our SN kids. This is their job, they see mnay kids, with many disabilities all day. They will figure out what works for her and what doesn't. Give them time to figure her out and give her time to adjust. I'm nt saying it's going to be easy, but she may just surprise you with how well she does. Just promise me one thing...take advantage of your "free" time and catch up on some sleep!!

Can I ask a favor...can you take down the birthday clock?? I am freaking out because I have done NOTHING to plan for Ben & Connor's party yet and your clock is stressing me out. AAACK :)

Good luck with everything and keep me posted!