Thursday, February 28, 2008


The insurance claim that was supposed to be paid for Bubba, never was. After months of saying they would pay it, reprocessing it, and then denying it, they now tell me I have to file an appeal. So I am gathering letters from the doctor and dentist, records from the hospital, and all of my notes so that I can file an appeal and a complaint with the state insurance commissioner.

I also have to file an appeal because they have told me they will not cover Moosie having more extensive dental work done, even though he is required to go under anesthesia because of his disability and the inability to do the procedure in a dental office. Meanwhile the insurance company also denied a request for a gap extension. We have no in-network pediatric occupational therapists in our area, so we filed for a gap extension. They denied it saying that there are pediatric OTs knowing full well that there is not. They gave me a number, which of course I called, and they said they are an adult provider and have been forever. But the case is closed I am told and my only recourse is to appeal. Meanwhile...we pay out of pocket for both boys.

It really does get tiring advocating for things that you just shouldn't have to fight for. I'm so tired of being part of so many systems where I have to know all of the rules and not let them beat me down and make me too tired to care. I have part two of Bubba's IEP meeting next week. Some days I just want to crawl into a hole. Some days I do.

And what's even more frustrating? I spent over an hour calling number to misleading number trying to figure out what our mental health benefits are so that I can talk to someone as my anxiety spikes. I've gotten everything from "you're not in the system so call THIS number" to "our system is down, so call back." It's a good thing I still have some wits about me. I still haven't found anyone to help.

So forgive me as I don't write as I jump and fall from one broken system to the next.

The good news is that I finished our taxes and we already have our refund. And I finished applying for a grant (to help with the dental costs). Let's hope it pans out.


Niksmom said...

Geez, I'm so sorry to read about the insurance situation. I hope things work out the way you need them to.

Stimey said...

That kind of thing is sooo frustrating. Good luck to you! :)

Casdok said...

Systems are so frustrating, i feel for you.

Sarah and Jack said...

Oh honey. How can I help you?

Shoot me an email and I will give you our phone number.

Kelley said...

That sucks. Really. As if we don't have enough to deal with.

When MPS had his breakdown there was no help unless HE fought for it. I wasn't allowed to do it for him. Therefore no help. Cause he was too far gone to fight for it.

Will be thinking of you.

Anonymous said...

So sorry you have to work so-ooooo hard for everything for your boys. They have one fantastic Mom :hugs: K.C.