Story of getting a stander pt 3

Within two hours of submitting for a medical review our claim was denied. Based upon the diagnosis there is not supported  documentation in medical journals that show a stander is a necessary piece of medical equipment.

I told her I had only one question.

Is there a diagnosis out there that does qualify for a stander?

She said no, not in my experience. There is no proper documentation that shows it to be necessary for any diagnosis.

Appeal information is coming in the mail. I'm going to appeal this. I have an advocacy group I'm contacting on Monday for help. I cannot let this issue go. Andy has received a stander from TRAID yesterday that fits. We do need a tray for it and we are open to anyone who might be able to help put one together.

If I let this issue with the health insurance go, not only am I letting down Andy, I am letting down every parent and child suffering that needs help with a stander but this insurance company won't help them.

I will change everything I can for Andy. I will make this world a little different. I am only one person, but every time something changes it is one person and it is everyone at the same time.

Story of getting Andy a stander pt 2

I'm stuffing puffs in Andy's mouth as I type in hopes of him letting me have a few minutes to write this up. Starting yesterday, at around 4pm when waking from his nap, he's been screaming. Not for a particular reason, except he wants to be held. Mommy can only do so much holding!

I called the health insurance company to verify what steps needed to be taken to acquire a stander since our insurance became active today. What do I do with the prescription from the doctor? How do I submit for a medical review?

I'm told to contact the in-network provider I was given, and to give them the prescription. Called the company and they don't sell standers. During this, I received a voicemail saying the prescription is ready. Have I mentioned what a great team of doctors we have on our side? His orthopedic doctor is going on vacation for 3 weeks and she made sure it was ready.

I called the insurance company again. (This is call #3 for those counting) and this time I'm told that I should read the prescription to them when I obtain it, that's how the medical review process works. Once that's done, they will provide me with more providers. I drove out to Utica, and called to submit the review from my car in the parking lot. It will take 3 business days. I should hear back on Tuesday or Wednesday of next week.

If not approved, I confirmed there was an appeal process.

I'm nervous because instead of stating cerebral palsy as the diagnosis requiring the stander, the diagnosis code his doctor provided was for hypoxic ischemic encephalopathy. This is the initial cause of everything that's involved with Andy's condition.

Here is a link if you would like to learn more about hypoxic ischemic encephalopathy.

http://emedicine.medscape.com/article/973501-overview

Story of getting Andy a stander

If I tell you the story of how we got a stander for Andy I would have to start at the beginning. The very beginning.

Back at the beginning, both myself and my husband were unemployed. My husband was finding odd appearances he could make, sometimes he had one or two a month, some months he had none. We lived in a one bedroom apartment in NYC with my in-laws. It wasn't easy, it wasn't as hard as others had it. My husband looked for work for 18 months until he received the call from Oneida County. Our number was called. A call that so many college and law school graduates never receive.

We still struggled mightily. We were thankful for the food on our table, and Andy's medical bills made us become very far behind. Then a light came- help from charity for children, a local charity in Syracuse. They help us now with the medical bills.

In July of this year, Andy's physical therapist informed me he was getting to the age where a stander would be beneficial. I had never heard of this device before. She put in a request with TRADE for Andy to receive a stander when one became available. At last, in September, one was available.

A very nice man who worked at UCP drove it home for me in his pickup truck because it would never fit in my car. We placed Andy in it, and it was FAR too big. We returned it shortly after.

And we waited. And waited. I called my health insurance company at the time, and they only cover 50% of medical equipment after a pre-authorization process. We waited some more.

And opportunity for better employment came open to us, and my husband applied. He was offered the job, and with the job came a new type of health insurance.

I prayed. I don't talk about praying often, it's intimate for me, but here I am talking of it two blog posts in a row.

I took the leap of faith. I told Andy's PT that we could not wait any longer. It is November, it's been 5 months. Begin the process of getting the stander, we will go through the new health insurance and whatever they don't cover we will figure it out.

AKA we might eat ramen noodles for months. We will figure it out.

Let me explain what a stander does. It stands a child who may or may not have head control. By being in the standing position, bones and muscles continue to grow and develop properly. Unfortunately if a child with cerebral palsy does not have one, he or she will most likely need surgery to correct the damage caused by not having one. It increases the chances for a child to stand, and one day walk with or without assistance. It increases general health as well.

I received a call last night from the therapist. She told me the company she uses to obtain medical equipment informed her the stander would cost $2,000-$3,000 out of pocket. We would pay them directly, then if, and only if because a lot of insurance companies do not cover them, we could be reimbursed by our insurance for the amount they cover.

I cried for hours. The guilt was so overwhelming I couldn't eat. All I could think about was the physical possessions that I've so selfishly acquired during the last year. Especially the vehicle that I drive. Would I not take back that vehicle if I could so Andy could have a stander? What value did my personal belongings hold if I could sell them to give him what he desperately needs?

It was a rough night. And despite what everyone tells you, daylight brought no relief.

I finally called our new health insurance company, our coverage starts tomorrow.

If you provide them with medical information and a prescription and wait for approval, and go through an in network provider, they do 100% coverage with nothing out of pocket.

Now I've called and left voicemails for therapists and doctors. I'm ready to do this.