Smacking Our Heads Against the Wall

If you've been following the Insurance-Sick Child drama, here is the latest and not-so-greatest.

Last Wednesday, Blue Cross (yes, I'm releasing their identity) called to inform us that our appeal had been denied - there still was not enough evident documentation to prove our son's medical necessity for his immunolglobulin therapy. Not only that, but they told us that any further inquiry would have to be filtered through our provider (OR, "We're not going to talk to you anymore about this). When I mentioned his hospital stay last weekend, they said, "We do not have a ruling on that admission yet. However, it has no bearing on the case at hand."

HUH? How does it not have bearing? The child had strep AND pneumonia!

Hot, steamed, red faced and overly angry/emotional, I immediately called our congressman's local office who kindly offered to call the insurance commission on our behalf. Within minutes, the insurance commission was on the phone with me, asking for the case history. After providing it, they sent me forms for a review and a list of things to provide, which I started working on.

Simultaneously, we are working with AccessMED in Kansas City to have a round of the IVIG serum donated by CSL Behring so that he can have a treatment in March.

Flash forward three days. In the mail, we received a statement of benefits stating that we did not go through the proper pre-certification procedure when he was admitted on 2/13 at 1:30 a.m and that his stay was being reviewed for medical necessity.

HE HAD STREP AND PNEMONIA AND WAS SEVERELY DEHYDRATED AND VOMITING.

So where are we now? This morning, a six-page letter was sent to the insurance commission and paperwork for patient assistance was sent to AccessMED for serum.

It turns out, we aren't alone. Look what we saw on TV this weekend. We might lose. But at least I can sleep knowing that we're fighting for our son and his right to feel "not bad" (since he doesn't ever feel "good.")