Insurance Battles

The day we visited the Hanger for Cannon’s helmet we asked if they could go ahead and seek the approval through our insurance for coverage of Cannon’s helmets.  We had been warned that at times insurance companies did not approve for such items to be covered.  We were told when information from our insurance came in we would get a call to be told whether or not the helmets would be covered.  The helmets are very costly.   They cost about $2,200 a piece and Cannon will need a total of three to four during his treatment.  If one cannot afford the helmets or cannot justify the cost of the helmets then this surgery would not be an option.  We agreed knowing that this would be a possibility but left hopeful.  We left agreeing that this was no choice.  This was the surgery we wanted Cannon to have and if it meant bending over backwards and strapping ourselves then that is what we would do.

The call came on Wednesday, the day after we had found out about the surgery date.  I was told that the initial request to our insurance company was denied.  The insurance company considered this expenditure to be an exclusion on our policy/plan.  Where do we go from here I asked?  Well we had no choice.  If we did not have the amount of money in full at the time the helmet was ready then we need to delay the surgery until we had the cost upfront.  I asked if there was financial assistance or a financial plan to be put on.  I was given a list of eight places that help in circumstances like ours, but, one was not applicable for residents in our county, one did not help with helmets, several of them we did not meet the income rate per house member ratio, one required the child in need to be on the previous year’s tax return of which we did not have Cannon on our 2011 income tax return for obvious reasons, he was not born in 2011, and the last two did not offer online applications or even requirements.  I didn’t know what to think.  I didn’t know where to turn.  Again, we were so close that we could feel it, knowing that this was the right choice and now this hurdle.  I decided to call the next day to talk to the nurse in neurosurgery maybe she would have a solution that I hadn’t thought of.  But now once again, I had to wait until the next day and be with my thoughts all night.

Nighttime was the worse.  It was when I wasn’t busy that my thoughts would turn dreadful.  I would think about things, but nothing could be resolved because there was no one available to call.  The house was quiet and I would just look Cannon peacefully sleeping and cry.  I tried to cry quietly so I wouldn’t awaken anyone but inside I felt like there was a dam breaking.  I felt like my heart had shattered.  It made no sense.  It still does not, but I would think of things I could have done differently, but I had done my best.  But here we were still in the same situation.  It was then that at times I would be angry, I would doubt God, I would cry out for Cannon to be healed without the need of a surgeon, I would get online and search and search and search until my eyes begged me to stop and then I came across this. http://www.craniokids.org/support/entry.php?59-Confessions-of-a-Cranio-Mom
Finally, someone else who wrote it all down, who put it into words, who made it all make sense to someone looking in.  It didn’t ease the pain but finally, I was resolved to understand that there are others out there who are going through it who have the same thoughts and feelings who just like me. 

I felt calm again.  The tears would stop because of the exhaustion and then in the morning it all felt right again.  My days became full of phone calls, research, and frustration but at least there was someone, anyone, everyone that I could talk to or look at and not have to think about what was to come. 

I called the nurse.  I spoke with her about the insurance stating that the helmets would not be covered and very matter of fact she asked if I had gotten the surgery precertified.  I wasn’t quite for sure what she was saying.  She stated that it was my responsibility to have the surgery precertified. 

That hadn’t happened already? 

I thought prior to even meeting with the doctor this had to be done because otherwise we wouldn’t have come.  We had to do what?  We had to contact the insurance company and get the surgery preapproved?  “Yes.” Yes????  Okay.  But insurance would cover the surgery right?  “Not always.”  Not always?????  WHAT?  So this may not even be an option.  “Well, often if insurance doesn’t cover it then the parents normally just pay for the surgery out of pocket.”  WHAT?  We were thinking we would be out of pocket for the helmets not the surgery also.  We could justify maybe the cost of all the helmets but now also the entire surgery?  Who do I start with? 

My insurance company.  GREAT, just who I wanted to talk to right now!  Good to know that I needed to do this, again, all on the way into work. 

I whipped out my card and called the insurance company.  As I was speaking to the first customer service agent and explaining my situation she told me that no, I in no way could get the surgery precertified.  That was the job of the doctor’s office, the hospital, the surgeon’s office.  The information had to come directly from them stating that there was a definitive need that Cannon needed to have the surgery.  GREAT!  Back to square one.  Okay, but at least I knew now where to call.  She then transferred me to benefits so I could discuss the helmet situation with them.  The customer service agent there went on and on about what is covered and what is not.  I had to stop her midway through though because I had children about to be ready for the school day.  This was the second to last day of school, the last Wednesday ever in kindergarten for these kiddos!  Again, I had to put on my happy face and pretend, pretend that I wasn’t about to break under the stress of all this.

On my morning break, I called the nurse back to tell her what I had been told.  She then told me that I needed to talk to the precertification department at the hospital and transferred me.  I then had to leave a message and wait.  Just what I wanted to do (NOT)!  By lunch, I still had not heard back from anyone.  I called again, and again I had to leave a message.  I called my mom just to vent.  This was CRAZY!  How do we go from thinking that insurance isn’t going to cover the helmets but at least the surgery because isn’t that what insurance does? Right?  I had been tired of hearing from insurance “elective”.  How was this elective?  My son’s brain did not have enough room to grow in a normal fashion and yet you think that this is elective?  I would never sign him up for such a surgery if it was an elective. 

This was our only choice.  My afternoon kiddos arrived and I still had yet to hear back.  At this point I was frantic.  I tried again to call our nurse, our insurance company, the precertification department, anyone who could help give us answers.  My break ended too soon.  I was not able to get a hold of anyone with answers.  I broke.  I had to ask one of the counselors to cover my room for just a minute.  I needed a moment to collect myself.  I needed confirmation that I was strong enough, that I had the strength to go on because right now in this moment it didn’t feel like it.  I called Chase, he didn’t answer.  I called my mom, just the sound of her voice sent me into a hysteria.  I wanted someone, anyone to take this away.  It didn’t make sense.  It wasn’t okay.  I had asked for help.  I had cried out to God to take this away.  I begged and pleaded and yet here I was again, fighting this uphill battle and yet I was ready for the war to be over.  I calmed down.  I had a job to do and I needed to get back to my kiddos, it was what they deserved.  I walked down the hallway headed to my classroom.  With every step I was begging and pleading, please, do not let insurance be the determining factor.  PLEASE!

My phone rang.

“Ashley?”

“Yes?”

“Hi, this is precertification from CMH.  I wanted to call and let you know that we received an authorization notice from your insurance.”

“What does that mean?”

“It means that insurance approved coverage of the surgery.”

“Could you please repeat that?  I think you said that it means insurance will cover the surgery?”

“Yes, insurance will cover the surgery.”

RELIEF!  Thank you, Father!  Once again, there He was, in the midst of it all!  Sending answers from heaven, guiding us through the approval of insurance, from the phone call of someone I didn’t even know.  THANK YOU! 

I asked about the helmets but unfortunately that was strictly handled through the Hanger. 

The day came to a close and I still did not have all the answers, but at least one answer was very clear, on June 4th Cannon’s surgery to endoscopically correct the premature closure of his sagittal suture would be taken care of.  I looked to another heart wrenching night of not knowing about the helmets but at least I could breathe again.

I picked up the boys.  On the way home from daycare my phone rang again.  This time it was Chase.  “Ashley, the helmets will be covered too!”  What?  In between my earlier conversation and the current time the Hanger had called Chase and told him that they had received an authorization number but insurance would not inform them of the coverage amount, that would be our responsibility.  Chase called the insurance company and got a hold of one of God’s earthly angels.  Originally, full if any coverage would be difficult to approve because of our policy.  Chase went in great depth about the entire procedure and the need of the helmet.  Chase was told that at times policies are just numbers but this case became a story.  Ultimately, after doing checking and proofing of the policy Cannon’s helmets would be covered in full until January 1st, as we then will need to meet our deductible again before receiving full coverage on the helmets.  HALLELJAH!

God you are good!

You are so good!

To go from one extreme of desperation to utter joy, this was truly a day touched by the hands of our great Father in heaven! 

We thank you forever and ever!