Well, I got the phone call I've been waiting for this morning. A sweet lady named Mollie called from UCD's managed care department to tell us that we've been officially denied our request to go to Stanford. The reason is that they have determined that UCD can offer the same level of care as Stanford. I disagree. Other bad news: they can also offer the same level of care as UCSF. So we've been denied to go there too. Because our insurance is POS we can choose to still go to Stanford and pay a 20% copay. So, what is 20% of a million dollars...oh, way more than we have to spend.
Of course I sobbed on the phone with Mollie (poor thing, I bet that happens a lot) and she said she is going to help us find a way. She is going to contact CCS to see if we qualify (we definitely don't qualify for income, but we may be able to qualify with specific diagnoses) and they may cover the copay. The other option is to begin the appeals process, which I probably will anyway, but I have to wait until I receive the denial letter in the mail and then the process takes about 30 days. We only have 37 days until our scheduled surgery date at Stanford. Of course, the final option is to just schedule surgery at UCD.
My heart is heavy. I am so disappointed. I was really hoping and praying that we would be approved on the first try. I know it's not the end of the world, and we have time to work it out. I know Drew will have the surgery that he needs and it is in God's hands. But it is so frustrating. We already had a date and a plan and it feels like we are starting over from square one. We have made plans for the summer around a surgery date of May 23. If that date changes, so do all of our plans.
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15 comments:
There's nothing wrong with trusting God, but still being heart broken by it all. You have every right to be disappointed, angry, anxious, sad... Even I was hopeful that it would just fly through the insurance folks with an approval stamp. How depressing! We will just keep praying! Sending you big hugs!
Amy
Oh my gosh Andrea, I am so sorry. I'm sure there will be a way to make this work. Maybe Dr. Hanley can come to you!
I am so sorry, Andrea! We'll keep praying for all these arrangements to work out smoothly. Let us know if there is anything we can do to help!!
it is disappointing that it hasn't gone through smoothly, but you are right that it *will* be okay. i know these shakeups are especially hard for a planner like yourself, and if stanford is where you need to be in order to be comfortable, we'll all help make it happen. on a lighter note, when you said that your insurance is POS, i assumed you meant "piece of s**t." i'm trying not to be the only person that swears in your comments!
I am so sorry and I also sobbed. I will also now put it in God's hands. I remember your pediatrician said that it is always denied on the first attempt, so maybe its just routine. (Like this could possibly be routine!)
How about trying Dr. Hanley's office. He is the one that reached out to you through his daughter in the first place and might be willing to step in somehow because of that relationship.
I love you so much!
Mom
Andrea! Booooooo! I'm so shocked. I will be praying that God makes a way. Please let me know if there is anything I can do to help...
Hi Andrea
I am also disappointed. We shouldn't have to fight so hard for these things.
Do you have help or expertise in appeals? I think it will be very important to establish the criteria for "same level of care" service.
You may need to present research on the outcomes or expertise of the surgeons. I know if I was in this situation I would ask the families on the tChin PDHEART list for suggestions. I am sure some of them have faced something similar.
Shannon
OK, I got some info for you. Kim, in Dr. M's office, said that you need to get Frank Hanley to write a letter explaining why Drew's surgery needs to be done at Stanford (and not anywhere else) and then submit it with your appeal. She did say the hard part would be getting cooperation from his office. But, if they are not willing to help or are hesitant, Kim will get it done for you. Let me know.
This is so frustrating! I know you have put so much into making the best decision, and for the insurance company to do this just seems so wrong! But, I guess I never do expect things with insurance to run smoothly... urg! I do feel more hopeful after reading many of your friends comments, and maybe this is just a speed bump. I hope you feel more hopeful, too, and I'll be praying that things will work out as you planned.
OH Andrea...you made me cry!!!
I'm always whining about our insurance..but, they have never denied us coverage anywhere. I can't believe that they think you could get the same treatment anywhere else...Send them Dr. H's bio!!
I hope the appeal works and you can go. You sound like me when I'm calculating a percentage of a million dollars (because that's what it costs us each time we're at Stanford...but, that's because Isaac likes to linger!)
You let us know if we need to have a fundraiser....we'll raise the 20% of a million dollars...nothing but the best for your little man!!!
Hugs to you...
I can't imagine the stress this has just added to you...
breathe...
kathy
Don't give up Andrea!! And if you are gettomg tired of hoping and praying, we're all hoping and praying for you!
This is NOT something you should have to worry about right now! I'm so sorry you have to deal with all of this right now. I'm praying that things work out and you can get into Stanford because I know that is where you feel the most comfortable.
DO put it into God's hands and He will take care of it for you. Trust in that! In the meantime, we'll be sending up the prayers.
Andrea, I am so sorry that you are going through this. It is so disappointing to me when insurance companies do this...yes, you may get the same "level" of care, but this was the choice that you all made after TONS of research and examining. I will keep praying for you to get the answers that you are all comfortable with. You are right in putting your trust in G-d. Hang in there!
Heart Hugs,
Samantha
I could go on and on about trying to discern God's will and following His guidance. Jen and I have really struggled with this on our journey as well. I have to imagine that it's a bazillion times more difficult when your own child is involved. We'll be praying....
I also echo Valerie and Shannon's comments. A strongly worded letter from the doc at Stanford would probably go a long way to support your appeal.
PS....to Kate, POS is Point of Service, even though your acronym interpretation is frequently true ;-).
Oh Andrea, I am so sorry your dealing with this. I know this wasn't an easy decision to go to Stanford...then for you to be denied has to be overwhelming. Just breathe...and take it one step at a time. You received alot of good advice so start making your calls. I'll be praying that this will all work out.
Hugs!
Vanessa
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