Need to vent...my world...

[benEzra]

Under a bit of stress today...

:rant:

A few months ago, we found out that after approving, and paying for, a year's worth of feeding therapies for my medically complex, straw-fed son last year, Blue Cross Blue Shield has changed their mind--after the fact--and is "un-paying" for a year's worth of therapies that we could never have afforded out of pocket ($50K+ of out-of-pocket expenses for my son so far, we just didn't have anything left). So, they've stopped payment on the clinic's other patients until they've "un-paid" our son's bills from last freaking year (going back to March of '06). Oh, the joys of greedy insurance companies--I never expected to lump Blue Cross in with the Insuracares of the world, but I guess they're all the same, nonprofit or not...



Understandably, the small, locally owned feeding clinic has bills to pay, and crap rolls downhill, so they are now leaning on us to cough up an amount of cash worth more than my (10-year-old, 160,000-mile) car, and threatening to sic a collection agency on us. Have a nice day, and all that...

Thank God he has Medicaid, now (via CAP)...after four and a half years of paperwork...

On the bright side, here's a fairly recent photo of him, now 8, on the way to the cardiologist, after two surgical heart reconstructions (almost lost him both times), a year or two on full-time oxygen, seven angioplasties of the pulmonary branch arteries, a Ladd procedure for malrotation of the bowel, and a recent pharyngeal flap surgery to give him the ability to speak...bravest kid in the world...



This is our world:

http://en.wikipedia.org/wiki/22q11.2_deletion_syndrome

http://www.upstate.edu/uh/ent/vcf/about.php



OK, I feel much better now. Thanks for listening.

:grouphug:

[skygazer]

1. What a beautiful boy

I'm so sorry you're going through this added stress. That smile is something else, though. :hug:

[benEzra]

3. Thank you! (nt)

[SmokingJacket]

2. Those pictures made me cry.

How fucking dare they do that to you and to him.

You should try to get media attention for this story. It's really criminal.

*still crying*

[mzteris]

4. what reason did they give?

Fight it.

Get a lawyer. Free consultation. Many will work on a Contingency fee basis, too.

Call the local TV station - their "troubleshooter" person. or contact the newspaper.

What a travesty.

Your son is beautiful, btw.

[benEzra]

7. They didn't tell us at first...

just told the provider (not us!!) that they were going to take the money back. No explanation given, AFAIK.

After much pestering on my part, they finally told us it was because he was over age 7 when most of the therapies occurred, and they decided to reclassify the therapies (that they had already approved and paid for more than a year prior) under the neurodevelopmental category instead of whatever it was they had approved them under originally, which conveniently has an age 7 cutoff.

I appealed a couple months ago (after several months of trying to pry information out of them), and they said, "you're right, we'll reclassify it into the physical rehab category under which his physical therapy and OT is covered. And oh, that category conveniently has a maximum of 15 interventions per year (all types combined), which you exceeded in 2006, so we're still not paying them." I feel like they're playing a shell game.

It's only about $3000, and they've probably spent more than that already in wages fighting us and playing the shell game.

I am a tenacious bastard, though, and I don't have the money to just roll over and pay this, so we'll keep fighting. Just like the little old lady in The Incredibles..."they're penetrating the bureaucracy!!"

I am trying to get a copy of the Benefit Advisory they generated that initially approved these therapies (which stood for a year before they changed their mind). They won't release it to me, but I'm hoping they'll release it to the provider, per their usual practice.

The provider is already filing a complaint with the state insurance commission, and I am going to as well (plus the Better Business Bureau, though I don't know if anyone listens to them anymore).

[redqueen]

5. What a frickin cutie.

I'm so sorry you're having to deal with the asshole bastard avaristic fucker insurance vultures, may their greedy shouls rot in hell.

To brighter days ahead... :hug:

[Debbi801]

6. He is beautiful. Insurance companies suck.....

:hug:

Can you keep trying to fight their decision?

Thank goodness for Medicare. Can you apply on his behalf for SSDI?

[benEzra]

8. We did, and he is classified as SSI disabled, but

we are over the family income limits to receive benefits (they aren't allowed to look at expenses, just gross income, and I have a good job).

I could quit my current job and become a janitor in order to receive more benefits (I have a friend who had to do just that, after his son was born with hemophilia), but I don't think we'd come out ahead, and we'd lose the house during the 6-month waiting period anyway. Right now, he's receiving Medicaid under the CAP program, which allows the state to look at just his income and assets, so we're not required to live in a cardboard box in order to get him benefits.

The Medicaid is only retroactive to November of last year, though, and most of the therapies occurred between March and November.

We will definitely keep fighting, if for no other reason to make it enough of a pain in the butt that they won't try to screw the next family this way.