29 June 2010

Insurance is a pain.

It seems like all I ever do is fight insurance these days. It shouldn't have to be this difficult. I mean, who makes bogus claims for medical food, equipment and doctor visits? Do people really pick random doctors just to see if insurance will pay for the visit? Are they sitting around the dinner table and trying to figure out ways in which to mess with insurance companies?

More and more lately I am trying to justify and prove, beg and plead with BCBS.

Liam had an appointment with a developmental pediatrician back in February from a Dr that is not in our preferred provider list. I submitted the claim in March and in April I was still calling them trying to find out if they were going to pay. They finally put it in priority status and then I heard immediately that they weren't paying. BUT, they paid for the over $2000 of lab work that Liam had done at that appointment. What?

I appealed their decision on the dev. ped. and when I called today to check on that status they said they don't have the appeal. That's twice now that I have sent papers to BCBS and they have mysteriously not received them. And once the lab sent papers and they didn't get them. Humph. The lab said they "never thought BCBS would stoop so low as to say they weren't getting claims".

I also spent considerable time today trying to get them to cover Duocal (powered fat for food) for Liam. I finally found someone who said they would cover it under the medical benefits section of my plan since Liam is primarily g-tube fed. I hope they are right. Cuz Liam could sure use it.

We had an appointment with GI yesterday that yielded good news. Liam is now doing well enough on his new diet that we are going to start slowly increasing his volume intake. SLOWLY. Cuz I'm afraid if we mess with the good thing we've got going he's going to end up refluxing badly again. But he definitely isn't getting enough calories still, even though he's keeping everything down, so we need to increase it a bit. Unfortunately his weight dropped from the 5th percent to the 3rd percent in the last two months. He's holding steady at almost 25 lbs, but he shot up in height to the 25th percentile (wow) and it's thinned him out a bit. Hopefully getting the Duocal added will help make up the slack.

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