Saturday, December 7, 2013

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.

Thursday, December 5, 2013

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

Wednesday, December 4, 2013

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.

Friday, November 15, 2013

15 month check up

Today was Andy's 15 month check up. Let me share with everyone what we discussed:

He's no longer on medication.
He receives 4 therapies, 8 times a week total. We are increasing to 9.
His tone is reducing.
He's verbalizing.
He's gained a few ounces.
He's healthy.

And that's all. No talk of "milestones" or other measurements that try and push one child in front of another.

I am not ashamed. I am proud. I am not in the "milestone" rat race, and I do not believe that another parent is better then me because their child can hit those "milestones" that mine cannot.

Those "milestones" don't make the parent. Just like they don't make the child.

Wednesday, November 13, 2013

Praying for patience

Many, many years ago, I read where someone (on the Internet) wrote that if you were going to pray to God for something (a new car, better health, etc) to have the most success you must pray for the improvement of yourself or others (increased skill at work, a doctor's knowledge), to achieve your goal.

I was very impatient and easily aggravated. The most logical request to pray for was patience. If I could have just a bit more patience, I could accomplish anything and have peace within myself. I would meditate on this for hours. Some of you may remember when I chose to give up anger for lent; all of this in hopes of finding the patience I sought.

It was not until I gave birth to Andy, that I fully received my request for patience. Now I have all of the patience I would need. I have the privilege of practicing my patience everyday, as I care for a child who acts like a baby far longer then one typically would. Long gone are my expectations, and I can find happiness in everything, and take happiness from each day being the same.

Last night I had a dream that Andy said Mommy. Even if my dream never comes true, I will wait with patience.

For my little drummer boy:
 "Aaron's heart was filled with joy and love. And he knew at last that the hate he had carried there was wrong. As ALL hatred will ever be wrong. For more powerful, more beautiful by far than all the eons of sadness and cruelty and desolation which had come before, was that one tiny, crystalline second of laughter. Blessed are the pure in heart, for they shall see God."

Friday, October 18, 2013

I will always be 34th st.

As I wiggle "They're Real" mascara on my eyes, a very rare occurrence that I wear makeup these days, I'm taken back to when I would get ready for a day at Sephora. I hope that one day Andy can realize what his mommy did, and be proud of her. I used to dream of the day I would be in corporate, flying around the country to train others. My last few days at work I had taken over for a brand rep who was there sick and was teaching others how to use the products. I beam with pride when talking about my $500, $800 sales and how I worked at the center of the universe. Those skills have remained; they are manifested in how I teach others about who Andy is. And those are priceless. 

Wednesday, August 28, 2013

Gratitude

Yesterday we traveled to Rochester for another opinion. What I heard turned into the most humbling moment in my life. 

We saw Dr. Kwon. We wanted her opinion of the MRI's (she's reviewing and will call us back) and how she would have treated the IS had we been going to her clinic/when she would wean the Zonisamide. (We are currently going to start weaning in a week).

She told me that she had never seen a case of IS being brought to control as fast as Andy's. If he was seen by her, she would have began with phenobarbital and ACTH would have been the last resort after every other medication. She never uses Zonisamide. She also would have predicted a far poorer outcome then Andy has. She explained that this is difference between an older doctor set in their ways like herself and a younger one like Dr. Pugh in Albany. And they never would have known they weren't doing the best for him. 

How do I look Dr. Pugh in the eyes and thank him for saving my son's brain? I'm overwhelmed with gratitude and each word feels more inept than the next.