Final Weeks of Summer Vacation

Believe it or not, my kids only have three weeks of vacation left before they start back to school. Our school district is year round, so the summer breaks are short and the Fall and Spring breaks are extended. Since we don't have the luxury of spending our summers traveling from one vacation destination to the next (who does?), the kids are bored and ready to get back to school and their friends. We are contemplating a trip to Disneyland in August or September, but the question then becomes ... do we take Jack? It's not that we don't want Jack with us, it just changes the dynamics (exponentially) if we take him. If we decide not to take Jack, then Mark or I have to stay home which defeats the whole idea of a family vacation. Simple decisions become so much more complicated when you have to travel with your own PICU in tow.

The insurance "fun" has already started with our new insurance company. I received our first denial for home nursing care for Jack. Aetna claims that home nursing is not a covered benefit. Funny thing is, I've got a copy of the Plan Summary and right in black in white it says:

The Plan covers the following specialty and outpatient services, subject to applicable copay and any limitations shown in the “Summary of Benefits”:

• Home health services provided by a participating home health care agency, including:

- skilled nursing services provided or supervised by an RN.

Not sure what plan they are reading, but it seems to me it's quite clear that home nursing IS a covered benefit. I try not to allow myself to get angry over this kind of crap, but it still frustrates me to no end. I don't risk losing my nursing care over this bogus denial because Jack's nursing is covered by our State's vent dependent program (Medicaid). I don't really have to appeal this decision because we will continue to get nursing. However, it's the principle of the matter and just like with Jack's eye gaze communication system, even though Medicaid will pick up the tab, I refuse to allow insurance companies to get away with their lying and cheating ways. I'm sure after I point out that home nursing is a covered benefit, they'll find another basis on which to deny nursing. I'm going to beat them to the punch and address the most likely basis for denial in my appeal. More than likely the next basis for denial will be that Jack's care is "custodial" - ie: he doesn't required skilled nursing and that basically anyone can provide his care. You think I could drop him off at KinderCare and they'd watch him for me? Ignorant physicians stand in the position of medical director for these insurance companies. When we were in St. Louis the medical director for CIGNA asked me why I couldn't just schlep Jack and his vent to our local daycare. Seriously?!

Speaking of family outings, Mark and I are trying to be more committed to getting Jack and the rest of the kids out of the house at least once a week together as a family. There are many excuses as to why we can't take Jack out, but we've just got to push past them and do it! Jack needs to get out more, especially since his lame mom won't put him in school. We went to the movies this weekend - we took Jack and Eric to see WALLE (Hilary and Mary saw Hancock). Here's Jack checking out his Dots:


and Eric's sweaty hair-do:



That's all I've got from here. Until next time . . .

Smile and the world smiles with you