Friday, January 7, 2011

insurance battle

So, since Mateo was born, he has been on OHP for medical insurance... With 300k bills coming through for hospital bills, I am beyond grateful for the coverage. There are some downfalls though. They don't like to cover much when it comes to supplies. We went through a battle at the very beginning- a little over 2 years ago, to get the amount of supplies needed for Mateo, since his condition is different than most. The doctors did the fighting for me, as we were in the NICU for about 3 months....
Well, after surgery in October, his ostomy was revised, and he outgrew his pouches. I did some searching and some trial & error and found a pouch we like. I go through all the hoops, only to get a letter back saying the request for the amount of pouches (50 a month) was denied because it is over the allowable limit (20 a month). Having an ileostomy and liquidy stool, I change Mateo atlease once every 24 hours, if not more. And HELLO! there are on average 30 days in the month??
So here started my 2nd battle of trying to get Mateo his supplies... Phone call after phone call, getting the run around... Nearly drives me crazy! I do have to say I am beyond grateful for our surgeon, Dr. George Wadie. Whenever I need ANYTHING from him, he makes sure to get it done. He wrote new chart notes, sent a letter of medical necessity, as well as filed an appeal to OHP on our behalf to get Mateo what he needs!!! AND we are also grateful for the staff at Wound & Ostomy in the hospital... Whenever I am lacking supplies, or there is lag time before getting the next order, I simply have to call them, and they literally GIVE me what I need to hold me over! I am so thankful to have such amazing support when it comes to caring for Mateo!
I know this is pretty much a vent fest, but I post it just so people can see what it is like in our world. There are tons of hoops and hurdles and bumps in the road that we have to travel! And what i put here is just a small portion!

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