Monday, January 14, 2008

Denied

Yep, our insurance company, who I affectionately refer to as United HealthcareLESS -- denied Jack's eye-gaze communication device (technically called a SGD - speech generating device). UHC claims that "devices and computers to assist in communication and speech" are excluded from our plan. Apparently, either UHC or Mark's employer wrote it out of their plan sometime between 2003 - when Jack's first communication device WAS covered -- and now. I think I've figured out how things work. Each year the insurance company and the employer sit down and look at those procedures and/or equipment that were covered and which cost them a lot of money and then, they proceed to write them out of their plan.

Not that long ago, receiving news that something this important for Jack is not covered by insurance would have made me so angry I couldn't see straight. But, I've learned over the years that "que sera, sera" and, therefore, there is no sense in getting so worked up that I can't function. I really believe, if it's meant to be, it will happen. Besides, being angry just saps too much energy and my reserve is depleted.

While I'm not angry, I'm not throwing in the towel either. We have a couple of options. First, we move forward with requesting that our Department of Developmental Disabilities (DDD) pay for the device. They should cover it (I hesitate to say that they will cover it). But, as I mentioned before, if DDD pays for it, they own the device, we don't. Not my first choice, but livable. While we get ball rolling with DDD, I will be appealing UHC's decision. A fellow sorority sister of mine gave me the name of an attorney whose entire job is appealing denials of SGDs by insurance companies. The best part, he doesn't charge for his services because he is paid by the SGD industry. He and I already exchanged several emails and information today and boy, does this guy know his stuff! I'm confident that, in the end, UHC will be paying for Jack's eye-gaze communication device. Hopefully, DDD will approve it so we can get it right away, but when we win our appeal, DDD will get reimbursed and we will own the device.

Another day .... another battle. However, the difference today compared to a couple of years ago is that today I'm more informed, I'm more patient and I don't take it personal. Jack will get what he needs, not necessarily my way or in my time, but he will get it.

(I'm sounding so in control of my emotions, I'm scaring myself! Don't worry, I can still get angry when I really need to.)

Onward we march!

5 comments:

julie w said...

Phew Ann! I'm still at the angry stage - I'd be having a real rant if it were me. Though I realize that it doesn't really get you anywhere, it does make you feel better at the time.

This guy sounds like he can help, hope you can get the ball rolling soon.

Cindy said...

Our entire health care system is broken and needs to be fixed. That's what makes me angry. What if it was a liver that Jack needed? We should not have to put our time and energy into getting the things our kids need. Having kids with special needs is hard enough without this kind of time-wasting red tape. Grrrrr....

Anonymous said...

I'm glad you have the patience to get through this mess. I hope Jack gets his device very soon.
Kristy

Anonymous said...

When I saw the title "Denied" my very next thought was, "Knowing Ann, not for long!" It's just, WHY does everything have to be so hard?!?

Carol (Zachgram)

Christamae said...

Insurance sucks! I have been following your site for a bit. I frequent tracheostomy.com and have Muscular Dystrophy. I just wanted to say that MDA will pay or help to pay for a communication device...

-Christamae