After getting bad news yesterday morning, the rest of the day went fabulous! I opened a letter saying that even after appeal, Jax medical bed was still denied! I can't believe it, there must be no child in Utah with our insurance that has a bed. Because if Jax doesn't qualify, nobody will. It just makes me crazy to think that doctors are deliberately denying things they know people need. How heartless can these people be?
Instead of panicking, and thinking I'm about to enter into another battle for something my son needs and deserves, moving takes care of this problem. The bed wouldn't come anyway before we moved, so we'll start the process of getting a bed all over again with our new insurance. Plus I'm 99% sure that Jax will get the waiver in California, so getting the bed between the two should be no problem.
Now on to the great things that happened. I called a couple of our insurance options to see what was going to be the best fit for Jax. I already knew I didn't want Kaiser, I've heard bad things, and I want a PPO not an HMO, so I can take Jax out of network if need be. I called Empire bc/bs, where we have a couple different plans to choose from. The man was extremely nice, and we talked for nearly an hour. We picked the plan that will work for Jax, and he actually looked up the two doctors I have already picked for Jax. One is his cardiologist at Childrens Hospital Los Angeles, the other, his neuro, at the great UCLA. Both doctors are in network!!! Also, every childrens hospital is also in network!!!
I think this is the first time in my life that I've had a good experience with an insurance company. Of course we haven't had to have stuff covered by them yet, but this is a great start. He did tell me that if he was admitted, that they would have to call the insurance to get it approved. I didn't like that idea, because here, if it has to be pre-approved, its usually because they'll deny it! But he assured me it was just standard, and that all PPO's do that. Its just a technical thing, a quick phone call to let them know. I'm just used to the same insurance we've had for 13 years. It's an HMO, and the only childrens hospital we have is in network. So another question to all of you. Is it true, do you have to have admits approved with your insurance?
Catching flies!
We have to call within 24 hours if Anthony is in the ER or admitted. If we do not call, the insurance is NOT obligated to pay that bill. I usually call, but Children's in Seattle almost always calls before I do, so we've been covered so far, since A's adoption.
ReplyDeletewe have BC/BS of alabama and when we took rachel in for RSV/pneumonia we received a letter from BC stating that she was approved for her stay. lol! she was already in there and receiving care. so, i'm going to guess you'll be getting the same type of thing. i really like CINGA our old insurance but so far BC has been good.
ReplyDeleteSo, so happy for you! Glad things are working out! I have Tricare and I have to get preapproval for anything other than an ER visit.
ReplyDelete-Dee
Good news sometimes comes when you most need it,doesn't it?
ReplyDeleteLove to one and all.
Hi Lacey,
ReplyDeleteI don't have any other way of reaching out to you, sorry if this is weird. But you left a comment in my blog and I responded, but you might not have had it set to be notified of a reply.
I saw your response about Jax, but I would like to make sure I still get you into the Recipient List and into the e-mail queue if you'd like to be, can you e-mail me at klilly@creatusmaximus.com so that I can start that process?
If you don't wish to, it's not an obligation of course, it was just something for us to try to consolidate all the info and get a head count on how many pads we were actually going to need to seek out in our efforts.
Wow, it sounds like you're going to have things soooooo much better in California!! And yes, my PPO also requires a quick call to let them know if you're going to be admitted.
ReplyDeleteSoooooo ridiculous about the bed being denied. Just can't imagine why on earth they would do that?!?!
We have BCBS as well. That is part of admission's job. Usually when they see the diagnosis and the tests, or whatever being run there is no problem. We ALWAYS receive a letter about 15 to 30 days AFTER saying we were pre-approved. LOL!
ReplyDeleteWe have BCBS office here, so we know lots of people that work there. That is one of those things that applies to the "rest of us". Ha! Ha! Unless you are going for experimental treatment, I have been told that they almost NEVER deny for medically fragile kiddos.
Even ER visits, I think you have 24 to 48 hours after the visit to call and "pre-approve." I wouldn't sweat it too much with Jaxson. :)
Hugs!!!!
Can't WAIT for you guys to get to Cali!
Steph and Christopher
I, too, have Empire BC/BS through my employer and have had nothing but great experiences with them. We get preapproved for everything, but have never had one issue. And when I've called with questions...etc., I've always spoken with very knowledgeable, friendly, helpful people.
ReplyDeleteWe have tricare with medicaid secondary. Our hospital deals with letting them know we are in and we have never had a problem. So happy to hear that things are falling into place. Praying that the move will go smoothly.
ReplyDeleteThe only time we ever have to get authorization for an admit is if it something that is planned ahead of time, like a surgery or procedure. If we go to the ER or the Dr sends us for a straight urgent admit, there's no approval needed. I have never called before or after an admit, personally!
ReplyDeleteI have never called before or after an admit for authorization. The only time things need an auth ahead of time is if it's a planned amit, for a surgery or procedure or something. Anytme we are admitted from the Dr's office or ER, the hospital admissions people do the auth for us. We have never had a problem with a hospital stay, and we've had plenty of them lately!
ReplyDeleteI forgot to mention that we do get authorizations for every stay in the mail, always after we're already home.
ReplyDeleteHi, Lacey. I've been secretly reading your blog for some time now. I never commented before because 1) I don't have any children and 2) I don't have any relatives that have special needs so I don't have any experiences that I can share when you have questions.
ReplyDeleteBUT, I do have several health issues and have ended up in the hospital a couple of times. I have a PPO and each time I've gone to the hospital, even for just ER visits, they have to alert the insurance company. It even happens when I go see a specialist even though my insurance doesn't require referrals. I have never gotten any hospital or specialist visits denied.
Good luck with your move and I hope everything works out for you.
yeah for some good news finally!
ReplyDeleteand I wouldn't worry about the preapproval thing if everyone has to do it...if they ever denied Jax a admit when the dr recommended it, they'd be sued so fast their heads would spin
YAY! LOVE this post and all the amazing news you've shared! Though I don't post often, I also never miss a post, as I truly ADORE your precious family :) Praying for a beautiful transition, over here on the West Coast...You're gonna love it here! :)
ReplyDeletewe have bcbs here in vermont and they have always approved gabes stays -- never a problem.
ReplyDeleteLove the cute pics of Arina and Jax.....as always!
ReplyDeleteAs for insurance, we have bc/bs PPO, and I was going to say the same exact thing that Sarah Evans said. It is nothing to worry about at all!
We have United Healthcare PPO. For our insurance it is the responsibility of the PROVIDER to call for an admit, not the member. So glad you received some positive info from the insurance company!!
ReplyDeleteWe have BCBS too. I think there is an admit rule, but it was always something that the hospital took care of....Hope the new insurance works well for Jax!
ReplyDelete