Get used to the Stairs

Yesterday, Friday, Educators Mutual called us at 12:30 to tell us that we'd been denied once more.  Sad, mad.  Then at 4:30 on Friday we got another call saying we'd been approved.  Finally, an independent reviewer determined that the surgery was NOT experimental.  What a genius!  The insurance went over all the details to make sure we understood that it was "not in network" and that they would only cover 80% of the allowed amounts.  The 20% and anything over the allowed amount was ours to pay.  We didn't care.  This news meant we could do the surgery!  Thank you Educators Mutual. I immediately called Childrens Memorial Hermann Hospital, so they wouldn't cancel the operating room for Tuesday.  They too had faith that it would work out and hadn't cancelled the surgery yet.  Then I called the news to give them the latest for their 5:00 story.  Then I called my mom.  That was a sweet phone call.  I know this ...

Coming home today felt like we were calling off a big wedding.  Telling the guests to go home and pick up their gifts as they exit. Then we walked off the airplane and found ABC4 News there filming us.  Yikes!   The story aired tonight, and they did a great job covering the facts and explaining the situation. So the wedding is not off, and we are still fighting.  Our hope tomorrow is that we will hear the good news.  We will hear that the Educators Mutual has agreed to cover the surgery. Are we grateful enough?  Thank you.  Thank you. http://www.abc4.com/content/news/top_stories/story/Utah-parents-battle-insurance-over-Spina-Bifida/DAOusr3WRUuraDIEzk2Aiw.cspx http://s1235.photobucket.com/albums/ff438/milliekillpack/?action=view&current=UtahparentsbattleinsuranceoverSpinaBifidasurgery.mp4

Insurance denied again.  So ridiculous.  The medical director for the insurance was looking at out-of-date information and wouldn't review the latest trial which show the benefits of the fetal surgery and make it the new standard of care.  There is also a Yale study that shows the cost benefit to insurance companies by doing this fetal surgery.  In the long run, it will save them so much money by doing the fetal repair.  After much arguing, another independent review is happening right now, and we'll hopefully hear by tomorrow.  We have requested that this next review be done by an MFM... Maternal Fetal Medicine specialist, as opposed to a regular OBGYN.  The hospital had to cancel the operating rooms for tomorrow, so the earliest we can get in is next Tuesday, April 24.  The sooner our girl has the surgery, the better.  Every day that her spine is exposed and her nerves are surrounded by amniotic fluid, damage is being done. Matt just fini...

Went to the hospital this morning to check in for surgery. Bottom line, we were sent home after hours of battling with the insurance company. Our insurance has denied our claims and all of our efforts thus far. We are not alone though. All day we've been surrounded by amazing doctors and staff. They spent the majority of their day right next to us battling it out with insurance. We are exhausting all our resources, and I'm hopeful that things will still work out. We also have an attorney who wrote a letter and called the insurance on our behalf. The hospital will not do the surgery without medical coverage. Bottom line, the expenses could be more than we could imagine or ever hope to pay off if there are complications. And remember, only 20% do NOT have complications. I just don't believe that we've come this far only to walk away. We are spent and deflated. How much longer can this go on until we fly back to Utah and fight this battle from home? Our absol...

We got a call at 4:59 p.m. on Friday saying that our insurance has denied the surgery.  The reason: it's experimental.  Dumb.  It's not experimental.  The MOMS trial has been over for a year and has proven to result in significant increase for mobility and decrease of shunts.   If I was on Medicaid, then it would be completely covered.  So, I check into the hospital on Monday not knowing if this is going to be covered.  The hospital is doing all they can to prove that it is medically necessary, or so they say.  Why is it always a battle? So what is this worth?  Can we put a price tag on it?  Can Matt and I say, "We aren't doing this because we don't want to be in debt the rest of our lives?" I slept restlessly last night as I went over and over these questions and many more.  How does Matt sleep so soundly?  Again, he's the steady one that repeats, "Move forward with faith."