health insurance

Mission 6/6: Success.

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Yesterday Shannon got a call back from the insurance person she had spoken to a few days ago with the wonderful message that we had actually been pre-authorized. This means that Alex is now a go for his 6/6 surgery and will have a few extra months worth of hearing than the current FDA-recommended minimum. By the time Alex goes to his oral-deaf school, he will already have eight months of hearing under his belt.

I think I’m still in shock. I was fully expecting that we were going to have to file a formal appeal. We were all ready to start pushing things and calling whichever party had the ball in their court until we had our approval, but it wasn’t necessary.

I wish I could say what EXACTLY got us pre-authorized if it would help anyone else, but we can’t be 100% positive. Our theory is that the pre-auth department opened the case, saw that our surgeon had already stated why we wanted to go in early (I want to get whatever he sent in and post the important bits here), and also saw that Shannon and I were all over the process and clearly were ready to appeal hard, and decided at the end of the day that it’d be more cost-effective to push us through on the basis that they’d be paying for the operation a few months down the road anyhow.

So we’re thrilled. Alex is going to hear when our family and friends sing “Happy Birthday” to him in September, and he’s going to be soaking up sound when he’s still young. This is his best chance to have age-appropriate speech at the youngest age possible, and even though therapy and our work with him is going to be a huge part of the battle, it all requires the raw materials to be in place and now we’re in position.

Next steps: We have an appointment scheduled with our ENT / surgeon in mid-May to ask any questions we might have about the procedure and pick out what sort of accessories (remote control, extra cables, batteries, etc) we want to get along with Alex’s cochlear implants.  We’re still thinking we’re going to go with the Cochlear N6s. I want to see the full list of accessories we can get for it as well as an idea for what the limitations are on how much stuff we can get, but Cochlear’s website is basically a pile of shit so… we’ll see.

Thrilled to be in this position, though. A lot went down this week.

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Mission 6/6: Day Two

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Actually went pretty well.

For whatever reason, the ENT called Shannon instead of me, but the news was still what we would call “good.” They finished submitting the pre-authorization on Wednesday to insurance, which is great. I had a weird feeling that was going to slip by a week or something.

More importantly, they told Shannon that they (meaning the office and the doctor) are completely planning on filing a petition. Since we didn’t know if the doctor would have any sort of issue doing that due to time constraints or prior experience, it was really relieving to hear that they’re on board with fighting to make Alex’s June date a reality. While on the phone, Shannon told the office that we had also reached out to our audiologist and were getting something from her for the appeal and asked if there was ANYTHING else we could be doing. The person on the line said “no,” but I think I’m going to start compiling that list of research demonstrating the benefits of early implantation. I’d LOVE if I could find something that would imply that BCBS could potentially save money down the road by going in early, but that’s probably a stretch goal.

Next steps are to find out about getting Alex’s ears drained out, but I’m almost afraid of doing that too early for fear that the fluid gets drained in the next few weeks, only to come back right in time for the surgery. We’ll see how that goes, but the most important thing right now is to know that we’ve successfully rallied the troops. Starting this Monday I’ll start hounding BCBS about getting the pre-authorization through whether it’s accepted or rejected, and I also need to ask about the appeals process.

Kid wants to hear.

Mission 6/6: Day One

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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.