Day 63 - Wednesday February 15, 2012

I was so frustrated today I was about in tears--mostly because of insurance companies.  It seems so difficult working with all the "rules".  Of course, Mark reminded me that we're very glad that they're paying for things. Still, it seems that things could be a little easier.  It's almost a job that you need to hire someone to do (if you could afford it!).   Someone to make sure everything is authorized correctly, to sort through all the bills and make sure they are paid correctly, someone to notify all the providers of the insurance coverage, someone to call and be the advocate etc.  Anyway, today's frustration--we were all set to leave to our rehab appointments when we got a call from Sugarhouse saying that the insurance hadn't approved our second speech therapy appointment, so if we came we would be personally responsible.  Why I asked because Bridgett's insurance has unlimited outpatient rehab coverage.  She was very vague, so I got on the phone to the insurance company to see if things were still messed up about the premium payment, but no--everything was fine there. They gave me a direct number for the rehab to call to verify coverage.   I called Sugarhouse back and they said that Bridgett's first appointment was an evaluation appointment.  Then the evaluation had to be sent to the insurance company for approval of the number of visits.  Sugarhouse had sent this evaluation to my policy, even thought I had VERY clearly told them to send to Bridgett's and told them that my insurance WOULD NOT cover her at this point.  I had given them a copy of Bridgett's etc.  And then she told me it could take up to TWO WEEKS to get approval, during which time Bridgett would not be able to come unless we personally paid for the appointment.  I said look, she already missed a week of speech therapy since her release because you didn't have any available appointments.  Now you are saying she might miss two more even though we are covered.  Can't you just know we have coverage and let us come.  No, she said.  So I said fine I'll just pay for the appointment.  How much will it cost?  She said over $300.00.  You must be kidding!  So, twice a week for $300.00 for two weeks!  Crazy!  Of course, they reminded me that we still needed to come up for the physical therapy appointment, since if we missed without 24 hours notice we would still be charged. I said to them that I had called and made a big stink about payment of the policy and the insurance company was extremely accommodating when they heard the situation, even bending their rules and letting me pay over the phone.  I said you need to call them and tell them the situation and get this authorized right away.  I mean this is vital for Bridgett to get speech therapy.  She told me this is not my fault.  By the way, this is the lady I first met when I visited the rehab and I didn't like the place just because she was so unfriendly towards me.  But, they are in network and we are having to choose in network places.  And, the speech therapist is supposed the best.  Anyway, we did have the physical therapy appointment still and we still had occupational therapy at the low vision clinic so we still went up. By the way, the occupational therapy clinic is not giving us any flack about the insurance. They said, it will be covered and there's no problem here so no worries.   However, before I left I called and left a message with the U of U hospital rehab social worker and said that I was frustrated with Sugarhouse and it just wasn't working out and I wanted the name of another speech therapist.  By the time we got to Sugarhouse, the speech therapist came and interrupted our physical therapy appointment to talk to me and apologize.  She said she had personally faxed the evaluation to the insurance company and they had talked to them and explained the situation.  Apparently the insurance company had agreed to approve therapy in three days.  She said they would set up the appointments for next week on and she would stay late to accommodate us so that we got the appointments in.  The lady out front (who had called me that morning) set up everything and even rearranged a couple of appointments to accommodate us.  The lady up front actually acted kind of civil to us.  Maybe the social worked called and got after them--who knows.  Anyway, also before I left home this morning I called Bree's father (the girl in Jenn's ward that had a TBI).  Bree had told me that he had problems with in network/out of network coverage etc.  He works in the health care arena.  He said that the insurance company is supposed to do what's best for the patient, not just what's best financially for them.  He said, you need to play hard ball with them.  He told me exactly what to do.  He said we can get them to cover out of network providers and here's how.  Anyway, I so much appreciated his input.  Of course, we have a fight on our hands, but we can do it.  It would be so much better for Bridgett to see therapists here in Provo, with the exception of the low vision clinic.  Even traveling up for one appointment would be easier on her.  Right now, she gets a headache and neck ache traveling up, even though I did give her Advil before we left.  She gets carsick.  And, its so much to do three therapy sessions in a day, each lasting an hour.  And, they have to be scheduled close together so that we can get on and off the freeway without hitting rush hour traffic.  Anyway, there's lots of factors.  So, to work we go--fighting the insurance company!  As a note, she did great at the physical therapy evaluation.  They were amazed at how strong she is.  Also, occupational therapy went great as usual.  The optometrist came in and talked to us first about the glasses, and made an adjustment to the eye patch.  Also, he helped guide Kasey in some eye exercises for Bridgett.  They told us to do these at home as well.  Bridgett had a couple of friends come visit in the evening and that was so exciting for her.  One of them was Jacob and it was so funny because in the hospital she kept talking about her friend Jacob.  I couldn't remember anyone named Jacob so just passed it off.  He was the one that put her name in so many temples and tonight he said he would finish up the few that he didn't do so that her name had been in all the temples in the US.  Cool!  The other one was the boy she was dating previous to the accident.  He came to the ICU all the time and visited her at the rehab weekly.  She was so very glad to have them come and wanted them to stay longer, although it was late. She asked both of them to stay and play games with her and this was after they had visited and were ready to leave.  Actually, we let them come up late because we wanted to keep her up late because they will remove the peg tomorrow and she has to be fasting and sleeping in late seems like a great way to pass the time fasting.  That's another long story, but today's post is already too long!  More on that whole situation tomorrow.