Insurance Nightmare

I'm not going to bore you with every single detail, but Blue Cross is a thorn in my side and the cause of ALOT of frustration, worry, and tears for me and Jamie... well the tears part applies to me, not Jamie. Basically, our BCBS insurance only allows for Noah to have 30 combined visits of physical, occupational, and speech therapies per year. I discovered today that Noah only has 10 visits left for the remainder of 2010, then we get the pleasure of paying 100% out of pocket. Since we've been going to Huntsville, he's been receiving all 3 therapies at one facility so it's only filed as 1 visit each week. However, I'm trying to get him set up to receive his therapy in Florence. The kicker is that there isn't a place in the Shoals area that offers all 3 services, so I'll have to take him to 2 seperate facilities. Each of the places will file individually, so he'll be using up 2 visits per week and with only 10 visits left, that only allows Noah to receive therapy for 5 more weeks for the remainder of 2010. UGH!!! I had also hoped to get Noah in the Spider Program at Children's Hospital one more time before the baby's arrival, however, that would use up 12 visits (for each day he gets therapy) so looks like that's out of the question for 2010 (unless we arrange to pay out of pocket, which is probably out of the question b/c of how expensive it would be)... maybe we can do it in 2011 when our 30 visits are renewed. I'm pretty heart-broken over this.

I made the huge mistake of calling BCBS to find out why we didn't run into this problem in 2009(running out of visits before year end) and she told me she would have to look into it and call me back. I was under the impression that his visits had been filed differently in '09. Reason being that periodically throughout the year, I always call to check on how many visits we have used up. Last year, they told me he had not used any (which is why I was under the impression it was filed differently.) She called me back the following day to inform me that we had indeed, exceeded our 30 visits last year and they had not caught it at the time. So since she has now discovered this, she has to report it and we will be getting a bill for all the visits we exceeded!!! WHAT?!? I pretty much lost it, I was SOO livid.

As trying as it can be at times having a child that has special needs, I think without a doubt, the most difficult part is dealing with the insurance and financial part of it. It causes so much stress and anxiety for me... mainly because half of the time I don't understand all of the insurance talk but also because I want any and everything for my child and insurance limits what they will provide for him. As parents, we want to say that money isn't an object when it comes to the well-being of our child, however, when therapy costs around $200 per visit at twice a week, it adds up QUICKLY.

30 visits per year is great for someone who has suffered an injury and needs rehab to heal, however, it's not enough for a child with a delay or condition that inhibits them from doing the things that typical kids do. It doesn't even allow him to go 1x week per year, when it actuality, he needs it 2x week. Even if our doctor writes a request for an extension of visits due to Noah's condition, BCBS won't grant more visits.

Last week, we reached a solution that will get us through at least 10 weeks of therapy. By that time, school will have started back and he'll begin receiving his therapy through them, and I'm assuming we will discontinue private therapy. I'm still hoping that some way, we can make it work to get him back in the Spider Program. I'm just turning it over to God and hopefully something will work out!

I apologize for the ranting. I try to keep my posts (especially the ones concerning Noah) positive and hopeful, however this is part of the stuff we are dealing with, too. I'm not wanting sympathy by any means, I guess more so just to vent. We all know us girls need to that every now and then!