Friday, October 7, 2011

UGH Insurance!

What a mess.  I am not a huge fan of insurance companies right now.  I mean I am glad that we have good insurance but I am not glad that I have to fight to get what I need for my daughter.

Let me start at the beginning.  All of my kids have dairy sensitivities.  With each kid it has gotten progressively worse.  Butterfly I nursed for 6 wks and then she was on soy formula (don't judge me, I didn't know much about soy then).  Bee I successfully nursed for a full year limiting dairy and soy in my diet (see, learned more about soy by then!).  Bubby was failure to thrive at 3 months and was immediately put on Neocate because limiting dairy and soy did not do ANYTHING for him.  So with Dragonfly we knew we needed to start dairy/soy free right away.  When that seemed to do most of it but she was still really gassy we knew I had to eliminate gluten.  So I did.  And I would do it again in a heartbeat.  However, at the beginning of this month my supply dropped, drastically.  She would nurse and nurse and nurse and still scream because she was so hungry.

Enter, formula.  I knew we needed Neocate.  I knew that with the allergies/sensitivities that Bubby had we would be facing an uphill battle if we didn't.

Enter, insurance company.  In the state of MN, there is a law that states that if a formula like this is prescribed/deemed necessary by the doctor the insurance company should cover it.

Enter, frustration.  Since Dragonfly didn't meet any of the diagnosis' that are covered right away we had to jump through hoops.  We had to trial her on 3 or 4 different formulas.  Yep, so everything that I was so careful about avoiding in my diet I had to shove back in my daughters body.  The first formula we tried was Alumentium.  Fail.  I will spare you all the nasty details, let's just say the diapers were not pleasant.  Second formula was Nutramigen.  Fail, but not as bad as Alumentium.  Diapers were still pretty bad.  Third formula (and just because we had to try at LEAST three), soy formula.  EPIC fail.  I don't even want to go into how those diapers were.  One thing that I should mention is that before we started formulas, Dragonfly had not had ONE diaper rash.  Not ONE!  As soon as we started trialing these we got a MAJOR diaper rash.  Not just a red spot or bumps, I am talking open sores on her bottom.  I tried Triple Paste, Bourdreaux's Butt Paste, coconut oil, and Aquaphor.   I then tried what the doctor prescribed, Bryan's Butt Paste (made by a local pharmacist).  At this point, I couldn't get the stuff to stick. Her bum is so raw that the paste won't stick.  I took her to the doctor today and they prescribed another cream.  It is a cream they give to severe burn patients to help heal their burns.  That is how bad it is.  Even just writing this makes me want to cry.

I have had two weeks of sleepless nights because my baby can't sleep through the night because she hurts.  The crying in the middle of the night, she balls up because her stomach hurts so badly, and the gassiness is enough.  I am done with it.  If her bottom looks this bad what do her insides look like at this point???

On Thursday of last week we started this process of getting the right information to the insurance company.  By Monday we thought we had it figured out.  The insurance company faxed a form to the doctor and the doctor faxed the form back.  And we were told it would take up to 72 hours to get an answer.  Ok, 72 hours was Thursday.  By Friday morning when we hadn't heard anything I decided it was time to call.

I called as I was on my way to Fairmont.  I had to pull the car over when I heard this: "We never received a fax."  So you mean to tell me that I waited THREE DAYS for NOTHING?!  I was bawling.  I talked to an RN at the insurance company who was less than helpful.  You need to send in the form.  Right, did that.  I called my sister (who works with medical insurance companies and doctors) and had her point me in the right direction (that is of course after she calmed me down).  First step was to go back into my doctors office.  And since I was headed that way anyways, it worked out fine.  I walked in, still visibly upset but not crying anymore, and talked to someone about insurance, I don't remember who it was but she was so kind!  She helped me find the answers as quickly as she could.  I then got to see our provider and she helped us figure things out as well as one of the ladies who works with insurance.  We made a plan to re-fax the information and call the company right after to make sure they got it.  It was time for lunch so we decided that I would stick around Fairmont for a while to make sure that I could get EVERYTHING done that I needed to if there were more steps.

I was in the parking lot when I received a call from our doctor's office.  It was then that I found out that the insurance company lied to me.  They told me that they had not received the fax on Monday.  That information, ladies and gents, was FALSE.  They HAD received it.  They had denied the claim because not all the paperwork was filed.  Ummm, all you told us was that we needed this ONE form.  Well apparently, we needed more forms and from different people.  We needed one from our physician AND one from a durable medical supplier.

I got pretty upset at that point.  Why on EARTH would they lie to me?!  So after I calmed myself down I called the insurance company back.  I finally got a hold of a person who actually cared about what was going on.  His name is Joe.  Joe helped me figure out who needed to do what and he even called the pharmacy we will be purchasing the formula from to set things up on that end.  So now we FINALLY have all (I hope!) the paperwork in the right places and we wait.  Yes, we still have to wait the 72 hours for an answer.  So for another three days my daughter has to be on formula that eats up her insides.

The formula will come in to the pharmacy on Monday and regardless if the insurance company covers it or not I will be picking it up.  I have to.  I cannot do this to my baby any longer.  I am praying that the insurance company will approve it quickly so that we can get this dealt with on Monday.  I think the thing that makes me the most upset is that I didn't find out there was a problem until Friday.  The day that no one wants to do anything, much less deal with a crying mess of a Mom.

So, that is my story.  I hate insurance companies.  So much red tape to do the right thing for you kid.  I will say this.  If the insurance company chooses NOT to cover this, this will not be the last they have heard from me.  I will fight that tooth and nail.  According to our policy, this should be covered.

Sigh.  Time for some hot tea and time for bed.
If you made it this far, you are a saint!  I guess I really needed to get all of those details out.  I feel some better now!

I hope you all have a great weekend!
<3 Alison

1 comment:

  1. (((HUGS))) I'm so sorry, Alison. :( I can't imagine what you and Delaynie both are going through. It is so unfair! Just ridiculous. I hope she gets the Neocate soon, and that it is covered!!