To make a long story short, basically when Ellie was born and we realised then that she only had one eye, I contacted my health insurance as I was told by our paediatrician that we would need to be covered for prosthetics. In short my provider proceeded to tell me on numerous occasions that as this was a "pre exisitng condition" we would not be covered.... What the???
So me as a mother who only ever wished for a healthy baby was meant to be aware of this before my baby was born... you have to be joking.... That was a massive battle on my behalf, in the end I won, and they chose to cover me, however it was going to cost me an extra $100 a month (nice!!!)
Recently I put a claim in for Ellies first prosthetic eye, to which they adivsed me as it wasnt done in a hospital under a anaesthetic it wouldnt be covered.... what the??? Again I had to fight to ensure we were rightfully paid for what I thought we were covered for.
Now, I have actually been paid for the prosthetic eye, however we are still waiting on a payment for the eye socket expander that was inserted in early November 2009, that is 2 1/2 months ago... Now do you understand my frustration.....
Having a child with extra needs and complications is hard and stressfull enough, I shouldnt have to constantly fight for what I am entitled too. So today the insurance company asured me that it would all be finalised and I would be paid the entitlement for the socket expander...
Lets just hope they are right, otherwise it means another phone call... maybe I should start charging them for their time... Yeah right!!
Sorry to hear of the frustrations with your insurance provider. Really hope you get it sorted as the extra stress isn't needed!
ReplyDeleteThat being said, I haven't had to pay for Violet's prosthetic eye yet, has been covered thru medicare. But, it has always been done under a general in the hospital, so maybe that is the difference?
Mel - I find it amusing that the insurance company would not pay since the eye was not put in at the hospital under anesthesia - wouldnt it cost even more with the anesthestic fees and Dr. fees for that, etc? They just needed an excuse not to pay. ARgg. That is frustrating but I am proud that you keep fighting and winning.
ReplyDeleteHowever, this really should end. Do you have a local news station. You should email them the story. Ha. That will get the insurance company to be more agreeable. :)
Mel... i'll pray for you and Ellie. I know you are strong and keep it up ok!
ReplyDeleteLauren, you are right, you would think that as it costs more in a hospital they would rather that I not get it done there... who knows how they think and work... ha ha ha you think like me, as I have already threatened them with a local current affairs show if they dont get this sorted... not that I would do that, I wouldnt put our family through that on TV, but if it helps us get what we want then so be it.
ReplyDeleteSarah: I am interested in how violets have always been done under anaesthetic. What is the reason for this? Does it actually involve some sort of surgery or procedure? Ellie has to have the anaesthetic to have the mould taken of her socket to create the glass eye. But the actual glass eye going in is just done in his rooms, and we can take it in and out when we want. I am just very interested in hearing about how violets work. Thanks!