I went to find what I had written last about the insurance, knowing I had written about the 2nd appeal and I couldn't find the entry. In going back again today, I found where it was supposed to be! The entry on Thursday 8-6-10, near the end, I say there is always good news and bad news. I had written a very lengthy explanation of the bad news and I think I decided it was too much so I deleted it thinking I would rewrite it and then never did. Since it took me so long to write it in the first place, I totally forgot that I had deleted it! It all just goes to prove that my brain is mush!
The "bad news" was the details about the 2nd insurance denial. I gave a lot of details but today I will really only give just a few. First, obviously it was denied. We had the opportunity of "presenting" (only 10 minutes) to the 3 person committee by teleconference. We even had Dr. SuchNeibar on the line and gave her input. They didn't say a word until the end and with the first question out of the doctor's (from the committee) mouth, it was obvious he had already made up his mind before we even got on the phone. I truly do not believe that they had read all the documentation that we had sent. As you recall, one of the main medical issues was that Shannon's condition causes her to fatigue to the point that a trip to SLC to therapists would make the therapy sessions very ineffective. The doctor actually even recognized that by asking why the hospital didn't have a place for us to stay that was closer to the hospital! Ya, he asked that! Then he said, knowing that we are paying out of pocket for the current therapies, "why don't the parents just use that money for a hotel closer to the therapists?" He truly wanted to totally displace the family so Shannon wouldn't have to deal with the fatigue issues. Doesn't that admit that they know she can't travel to therapy? Then we get the denial letter and it says that her CURRENT conditions do not warrant more therapy! Well, first, she has made a lot of progress which is due to the fact that we have paid out of pocket for her therapies that they should be paying for this entire last month! She still needs the therapy, but not as much so she has remained in therapy. And we were appealing the denial of the services back 4 weeks ago. This, by the way for anyone who might want to know, is Regence BlueCross BlueShield. You can obviously tell that I get pretty steamed about the whole issue. I believe much of it is because we are private pay individuals without a big business client to back us up. We are easy for big BlueCross BlueShield to refuse to pay. We have been told that because they have the big bucks that we would not have a chance if we took them to court. Again, the little guy... We have 180 days to file our last appeal. This appeal goes to an outside group that is not supposed to be biased by BlueCross BlueShield. But they are paid by them and one of the voting members of the last appeal committee is the one that delivers all the documentation to the outside group. Somehow that doesn't give me a lot of confidence that it will be unbiased. So when we have taken a long enough break from the stress of dealing with the insurance, we will file the last appeal and see if it has all been for not.
Gratefully, we have had good therapists that have continued on with Shannon with us paying them. Continuity is so important. They have really taken Shannon a long ways. We are grateful for their efforts and their tolerance with all the challenges that they have faced!
With the update on the insurance, which was supposed to be posted a week ago, I will end this post and finish the one I started last night.