Mission 6/6: Day One

When I write this blog out, I think about it from the perspective of what I would’ve wanted to read when we had first found out that Alex was deaf, to know the details of how the whole process really worked instead of just reading vague¬†statements about how there were lots of appointments and lots of healthcare struggling. That’s definitely not a jab at the myriad amount of people who’ve currently written about the same topic, but I always appreciated it when someone went into a little detail, so I’m going to do the same thing here by giving the day-by-day events whenever anything happens on our mission to get Alex implanted as early as possible. Our current goal is to to try to keep Alex’s current surgery date of 6/6, and if that has to slip, the very next available date possible.

After all of the events that transpired on Tuesday, we decided to give our ENT until Thursday to finish submitting the pre-authorization before starting to call daily until it was done. We also wanted to start working on the appeal and gathering as much material as possible for that. To that end, we emailed our audiologist, who agreed to write something up for us on our behalf. She probably thinks it’s just a small thing to do, but we definitely appreciate the hell out of it, since her professional and veteran opinion carries weight. Anyhow, she said she’d try to get that out to us by Friday.

I left a voicemail with the ENT this morning saying that I wanted to confirm¬†(gotta use that word) that Alex’s pre-authorization for surgery was sent in and to also ask if we could go with a different ENT than who was recommended for Alex’s ear tubes given the aggressive schedule. When they call back, if they say that the pre-auth was sent in, I’ll ask about typical turnaround and see if there’s a number I can call to inquire about status, make sure it’s received / processed, let them know that this is six weeks away, WHATEVER I can do to push it along. I’ll also ask the ENT if they can start getting an appeal ready if that becomes a process, offering to help however I can in compiling scholarly articles, mentioning that we’ll have an official recommendation from our audiologist, etc.

I have a feeling that if we’re going to get burned somewhere, it’s going to be when the insurance formally rejects the pre-auth and the ENT doesn’t have an appeal ready to go shortly thereafter. I plan on asking allllll of the details around this, but BCBS’s appeal process can supposedly take around a month to complete, so a quick turnaround between rejection letter and filed appeal is key.

We’ll see how those calls go and I’ll be sure to write about what I learn here.

I’m starting to get the impression between the conversations we’ve had so far and from some responses we’ve had on our Facebook support group that not a lot of parents are too aggressive after health insurance initially denies the procedure. Personally, I can’t relate to that, especially given all of the research about the benefits of early implantation and just the raw prospect that he could be hearing and soaking up sound sooner than later. I’m not sure if we’re forging new territory locally here or not, but we’re definitely going to put up a fight.