I'm guessing this is what all of the hullabaloo was about during that whole Obamacare thing ... but honestly, I'm really shocked at the poor quality of the care we have received overall due to the way the medical system has to be set up.
Short history: It seems that, until about 1970, your personal doctor was able to keep track of your medical history and suggest the best course of action. Then, insurance companies realized, "wait a minute!," the cost of health care is going to skyrocket - we have to do something about this!
Enter the beginnings of the crazy system we have now. From my personal experience, because insurance companies are looking to keep their costs low, and they really can't pay for everything because there is so much illness going on (let's just assume that together, rather than they're greedy bastards). Therefore, the quality of care everyone receives totally sucks.
Take our case for example, my daughter has a pretty straightforward skull deformity. It usually requires surgery. Last November, I started the process to have that surgery done. By January, I had arranged the consult necessary and gotten the "OK, I recommend surgery" from Dr. Fearon. Due to Dr. Fearon's demand, we were not able to schedule until the end of March. So that's a four month turn around time. Not too bad for a serious surgery. Or is it .... is a four month turn around time really a good idea for such a serious condition? I mean, I was basically told my daughter would suffer insanely serious consequences, and it's takes several months to schedule the surgery to correct that. Something is a little off there.
But, wait, there's more! (eat your heart out Ron Popeil) Now our insurance company gets involved. We used to be part of a PPO and didn't have to get regular referrals and authorization, which are different, you know. We switched to an HMO last year, and I didn't do enough homework to realize the ins and outs of how this whole thing works. So then, we had to find a new in-network pediatrician and in-network doctors, which, in my opinion, aren't the greatest fit for our family, because we had a lovely relationship with our other doctors that are now out-of-network. But if I want to treat my one daughter for her skull deformity and my other daughter for some sensory issues, I need to beg my new pediatrician for a referral to those specialists I was already in a relationship with before I switched to my new insurance. AND THEN, even after doing all of that, I asked for a referral and didn't understand that an authorization was required for surgery. So, I wasted the time of those at my new in-network pediatrician's office (which they are a lovely and truly helpful bunch - they are working the insurance hoops too, otherwise, they don't eat), and I've now wasted a lot of other people's time (neurosurgery at Children's and Inova) and I've drunk a couple of glasses too many of the vino in the process.
So now, our surgery was cancelled because insurance didn't like the surgeon we wanted to go to. I have to go to surgeons who provide a surgery I don't want for my child. I'm having to visit providers I don't plan to go to, taking up their time and money from our insurance provider to see them. I've been of Children's National a couple of times now and I don't need to be taking up appointment slots. Furthermore, we received a second denial for our appeal and now I'm going to have to bother plenty of peoples at the Maryland Insurance Administration (also, a wonderfully helpful bunch and they have really caused all of this to move forward quickly).
All in all, this does seem like quite the broken system. Doctors are not able to practice medicine because they have to jump through hoops to receive compensation - doctors have to eat too :). They have to overbook themselves to make enough money to live and they aren't able to suggest the best care of their patients, only the care that is available in a small pool in their local area. That sounds like a recipe for disaster. We have experienced that disaster personally, and we don't have a truly complex case that involved multiple offices.
All in all, I've spent a ridiculous amount of time just in the last month going to appointments, making phone calls and writing appeals. That time should have been spent caring for my children, building up my husband and nurturing our family. I really feel for everyone who is at the mercy of this system and I pray that something can be done about it very, very soon.
Wednesday, April 1, 2015
Wednesday, March 18, 2015
Well, that was interesting.
Everybody just hold your breath. For the next week please.
After a lot of hard work, from some very dedicated people, UnitedHealthcare has denied our claim. While this wasn't completely out of left field - I do hope they jump on the "hey, get us things on time bandwagon!" It seems that we will need to reschedule our surgery but, through our appeal, we should eventually get the green light for surgery with Dr. Fearon.
It's possible that we could get that decision this week. It's possible that we could still have surgery on March 24th - but at this point it would only be by a divine act of God. Which hey, didn't He say something like that was possible?
Thank you for all of your prayers. Truly, they have sustained us. And hopefully they will bring about a positive decision for our little girl soon!
After a lot of hard work, from some very dedicated people, UnitedHealthcare has denied our claim. While this wasn't completely out of left field - I do hope they jump on the "hey, get us things on time bandwagon!" It seems that we will need to reschedule our surgery but, through our appeal, we should eventually get the green light for surgery with Dr. Fearon.
It's possible that we could get that decision this week. It's possible that we could still have surgery on March 24th - but at this point it would only be by a divine act of God. Which hey, didn't He say something like that was possible?
Thank you for all of your prayers. Truly, they have sustained us. And hopefully they will bring about a positive decision for our little girl soon!
Friday, March 13, 2015
The Authorization!
At this very moment, the only thing holding us back from successfully moving forward with surgery is to have the authorization paper faxed to the insurance company.
Seriously, every person is ready to move forward at rapid speed - just one piece of paper! Please pray the authorization is completed correctly and faxed quickly to the correct person at our insurance company.
THANK YOU!
Seriously, every person is ready to move forward at rapid speed - just one piece of paper! Please pray the authorization is completed correctly and faxed quickly to the correct person at our insurance company.
THANK YOU!
You did it!
"You did it! Now it's done!"
This children's song has been stuck in my head for the past 12 hours, or so, because WE DID IT! It's not quite done ... but to use an analogy, the birds are in hand, just not on the dinner table yet.
Yesterday, was an awesome day and I know that your prayers really got us through. I did a whole host of things, but mostly, spent about six hours on the phone and four or so hours in doctor's office with the girls. We got the necessary authorization and that will be sent to the insurance company today.
I will also get a letter from my PCP stating that delaying the surgery will harm Azelie's health and that should seal the deal to get an answer likely by the end of the day but at latest early next week. At that, my friends, is the power of grace. We fought hard and Jesus won. YES!
Thank you ALL for your prayers and positivity through this whole process. We are still not in the clear but I am confident we have enough time and enough people on our side, that this whole process will go smoothly to having our insurance company at minimum cover the fees associated with the surgery.
Please pray for smooth sailing behavior-wise for the little ladies and for all of the necessary paperwork to go where it needs to go (faxes like to get lost, people get busy and crazy stuff can still happen) .... it's not really over, until it's over.
Pier Giorgio .... enjoy that drink, my friend!
This children's song has been stuck in my head for the past 12 hours, or so, because WE DID IT! It's not quite done ... but to use an analogy, the birds are in hand, just not on the dinner table yet.
Yesterday, was an awesome day and I know that your prayers really got us through. I did a whole host of things, but mostly, spent about six hours on the phone and four or so hours in doctor's office with the girls. We got the necessary authorization and that will be sent to the insurance company today.
I will also get a letter from my PCP stating that delaying the surgery will harm Azelie's health and that should seal the deal to get an answer likely by the end of the day but at latest early next week. At that, my friends, is the power of grace. We fought hard and Jesus won. YES!
Thank you ALL for your prayers and positivity through this whole process. We are still not in the clear but I am confident we have enough time and enough people on our side, that this whole process will go smoothly to having our insurance company at minimum cover the fees associated with the surgery.
Please pray for smooth sailing behavior-wise for the little ladies and for all of the necessary paperwork to go where it needs to go (faxes like to get lost, people get busy and crazy stuff can still happen) .... it's not really over, until it's over.
Pier Giorgio .... enjoy that drink, my friend!
Thursday, March 12, 2015
An Insurance Snag
I hate doing things last minute. I'm a planner and enjoy planning until kingdom come. But it seems that life (ahem, Jesus) has put us in the precarious situation we are currently in. Obviously, He wants to be glorified through this whole thing because, get a load of this .....
We scheduled surgery about a month ago. Dr. Fearon turned out to be our of network - OK, not so bad, not so bad. His fees come to about $10,000. I don't have that, but I can raise that (thank you previous missionary work). But that would be all me and my effort.
So now, our insurance wants to deny the whole claim because we haven't gone through an in-network PCP to and in-network surgeon. We would owe all of our fees up front if we choose to go the self-pay route. All $43,101.00 of them. Now, I get it .... insurance companies have an algorithm and there are certain providers who fit into that. They then participate with UnitedHealthcare and UnitedHealthcare knows they are providing the best care within their guideline.
When you need a specialist, your in-network PCP can suggest another in-network specialist and again, United Healthcare knows that new specialist is totally kosher with all of their rules. Great. Find another in-network specialist.
Well, our story looks like this .... go to the wrong type of specialist from a non in-network doctor who doesn't participate with any insurance, get the incorrect information. Finally schedule with a neurosurgeon under a different insurance that doesn't require referrals for specialists. Move to a new insurance in a new state and see a whole host of non-network doctors that we pay for completely out of pocket to try to treat A, then attempt to integrate all of those medical records into a system that we have not been conforming to for about five years (that would be the children's pediatric insurance system). And you get the following challenge:
We didn't start this process with an in-network doctor. We didn't stay with and in-network surgeon and so we don't get coverage that we need.
Now before we grab our pitchforks, let's just look at this from the insurance perspective. They don't know if my non-in-network PCP is a quack or even a medical doctor (she is, FYI), so when she authorizes me to see someone, it doesn't mean much to them. Furthermore, they don't have any sort of data on Dr. Fearon and it would take them a bunch of extra time to figure that out. They ARE a private company, needing to make a profit, so that people can have jobs and our economy can continue to eek forward.
Soooooooooooo, we need to be able to 1) get a referral to an in-network surgeon, 2) get a second opinion from them, 3) weigh whether or not that surgeon is a better fit for us and 4) if they are not, write a very informative appeals letter about why the in-network surgeon is not as qualified to do the surgery on Azelie as Dr. Fearon.
And all of that basically has to happen by tomorrow afternoon. Right.
So, unless a ridiculous number of things - which I am prepared to at least attempt - fall into place in the next 48 hours, we are probably going to have to re-schedule.
Now, rescheduling isn't the end of the world. But I do have another daughter who also likes her schedules. She is prepared to get on a plane on the 22 (March 22nd, that is) and I think she might just drive herself, if we don't take her :) Also, my saintly mother is coming with us and has taken the week off work. And I've just planned about a ba-gillion things for the week of March 23rd! So please join me in praying for a miracle of bureaucratic might that the insurance company magically files it's paperwork quickly (me calling them every hour probably won't hurt either :)
Pier Girogio Frassati - dude, we need you! Pray for us! And have a drink for me because it's Lent down here.
We scheduled surgery about a month ago. Dr. Fearon turned out to be our of network - OK, not so bad, not so bad. His fees come to about $10,000. I don't have that, but I can raise that (thank you previous missionary work). But that would be all me and my effort.
So now, our insurance wants to deny the whole claim because we haven't gone through an in-network PCP to and in-network surgeon. We would owe all of our fees up front if we choose to go the self-pay route. All $43,101.00 of them. Now, I get it .... insurance companies have an algorithm and there are certain providers who fit into that. They then participate with UnitedHealthcare and UnitedHealthcare knows they are providing the best care within their guideline.
When you need a specialist, your in-network PCP can suggest another in-network specialist and again, United Healthcare knows that new specialist is totally kosher with all of their rules. Great. Find another in-network specialist.
Well, our story looks like this .... go to the wrong type of specialist from a non in-network doctor who doesn't participate with any insurance, get the incorrect information. Finally schedule with a neurosurgeon under a different insurance that doesn't require referrals for specialists. Move to a new insurance in a new state and see a whole host of non-network doctors that we pay for completely out of pocket to try to treat A, then attempt to integrate all of those medical records into a system that we have not been conforming to for about five years (that would be the children's pediatric insurance system). And you get the following challenge:
We didn't start this process with an in-network doctor. We didn't stay with and in-network surgeon and so we don't get coverage that we need.
Now before we grab our pitchforks, let's just look at this from the insurance perspective. They don't know if my non-in-network PCP is a quack or even a medical doctor (she is, FYI), so when she authorizes me to see someone, it doesn't mean much to them. Furthermore, they don't have any sort of data on Dr. Fearon and it would take them a bunch of extra time to figure that out. They ARE a private company, needing to make a profit, so that people can have jobs and our economy can continue to eek forward.
Soooooooooooo, we need to be able to 1) get a referral to an in-network surgeon, 2) get a second opinion from them, 3) weigh whether or not that surgeon is a better fit for us and 4) if they are not, write a very informative appeals letter about why the in-network surgeon is not as qualified to do the surgery on Azelie as Dr. Fearon.
And all of that basically has to happen by tomorrow afternoon. Right.
So, unless a ridiculous number of things - which I am prepared to at least attempt - fall into place in the next 48 hours, we are probably going to have to re-schedule.
Now, rescheduling isn't the end of the world. But I do have another daughter who also likes her schedules. She is prepared to get on a plane on the 22 (March 22nd, that is) and I think she might just drive herself, if we don't take her :) Also, my saintly mother is coming with us and has taken the week off work. And I've just planned about a ba-gillion things for the week of March 23rd! So please join me in praying for a miracle of bureaucratic might that the insurance company magically files it's paperwork quickly (me calling them every hour probably won't hurt either :)
Pier Girogio Frassati - dude, we need you! Pray for us! And have a drink for me because it's Lent down here.
Friday, February 20, 2015
Financial Assistance for Azelie's Surgery
For those of you who have expressed interest in helping us financially, you can find more information about that here:
Surgery for Azelie!
(see how that rhymes if you say it all catchy-like?!)
Surgery for Azelie!
(see how that rhymes if you say it all catchy-like?!)
Wednesday, February 18, 2015
Azelie Surgery Update
The details for Azelie's surgery, thus far:
Surgery will be done at The Craniofacial Center in Dallas
which is located in Medical City Children's in Medical City Dallas Hospital on
March 24, 2015 @ 12:30pm
Dr. Jeffery Fearon will be the head surgeon and will be assisted by a neurosurgeon
If you would like to commit to praying for us and all of the medical staff before, during and after surgery, please leave a comment (and a way for me to contact you).
Surgery will be done at The Craniofacial Center in Dallas
which is located in Medical City Children's in Medical City Dallas Hospital on
March 24, 2015 @ 12:30pm
Dr. Jeffery Fearon will be the head surgeon and will be assisted by a neurosurgeon
If you would like to commit to praying for us and all of the medical staff before, during and after surgery, please leave a comment (and a way for me to contact you).
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