Throw me a bone…
August 12, 2010 | Updates
Dear Insurance Company,
I’m not going to beat around the bush. I’m frustrated. Samuel needs a new bed and he needs it NOW! We’ve been jumping through your hoopes for 3 months now and I still don’t know if you’ll do the right thing.
When we originally requested preapproval, you said we didn’t need it for durable medical equipment. Luckily, my equipment company knows better.
After a month of badgering you, you finally conceeded we had submitted it under the wrong codes so we resubmitted.
Then, you denied it saying it was a “deluxe” bed and we should choose a standard one.
So, we requested a case manager and submitted a new letter of medical necessity that was extremely detailed on the need for THIS bed.
A week later, we found out you were “missing” the codes we had submitted 3 months ago. (Not surprising since it’s been T.H.R.E.E. M.O.N.T.H.S!)
So, we resubmitted…again.
And now, well, who knows. It’s all about the wait, I guess. But just in case you think you’re discoraging me, you’re NOT. You’re just ticking me off!
Remember all the things we discussed?
How Samuel can roll, but doesn’t understand falling? How he moves constantly and forcefully? How he is at huge risk for entrapment in a “standard” bed and how the bills for broken bones, concussions and additional brain damage from falls and suffocation would be MUCH, MUCH MORE than the cost of this bed? How he already broke his leg once when his bed wasn’t fully enclosed and padded because he put so much force on the leg while it was trapped? And how we need to HURRY on this because his current bed is a hazard to him now that he’s so big and weighs so much? Do you remember? (Because you didn’t seem to care when I was making you listen to all this.)
Well, this morning at 5 am, I was awakened by the sounds of Samuel struggling in his bed. I figured I’d give him a few minutes to see if he would go back to sleep. But as I groggily rolled back over, I felt the need to get up NOW. Maybe it was the “tone” of his voice. Maybe it was the voice in my head. But I got up and went downstairs. And as I opened the door, I knew something was wrong.
For the second time in a month, I found Samuel’s leg UNDERNEATH his mattress. Last time, he was kneeling on the metal springs and his knee was bruised for a week. This time, his leg was bent and his knee had slipped through the springs and was SERIOUSLY STUCK (bearing all his weight on that leg) while he flailed trying to get away from it. It was clearly painful and my first intinct was to just PULL the leg out as quick as I could. But as I started to pull, I felt it wasn’t right, so I let go, reassessed, moved his body a little, bent his leg a little and carefully removed him from the springs.
By then he was crying.
Do you have any idea how that tears at my heart?
I’m sure you don’t or I’d have a better bed already.
The bruises down his leg will remind me for the next week how frustrated I am with you.
I understand that you can’t give everyone everything they ask for. But this has been ridiculous. If you don’t believe my doctor or myself when we say this bed is medically necessary for Samuel, then take a road trip and come see for yourself. Or better yet, I’ll drive to you! Just throw me a bone here and let’s get this taken care of. I wasn’t born yesterday. And it’s not like I don’t spend 24/7 with this kid. I KNOW what he needs and I’m NOT making this up.
And by the way, you have been so pleasant to work with until this year and suddenly, everything is DENY, DENY, DENY. If you think I think this has something to do with the whole universal healthcare mojo, you’re absolutely correct. And it sucks!
Well, I guess that’s it for now. I’ll go ahead and call you three times a day every.single.day until you finally get this figured out. And in the meantime, if we show up in the ER with a broken leg, you can bet your butt I’m gonna say, “I TOLLLLDDDD YOU SO!”
Sincerely,
Mama Bear
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August 19th, 2010 at 3:14 pm, Natalie Says:
You should so send in a copy of this letter to the ‘head honcho’ at the insurance company. I hope things sway in Samuel’s favor and he gets his new bed SOON!
August 25th, 2010 at 10:57 am, Sylvia Says:
….sickening is all I have to say. If I knew how, I would send this to FoxNews or Glenn Beck…..that would get them to give you a DELUXE bed.
August 25th, 2010 at 1:49 pm, Gramma Jewkes Says:
That’s terrible, Teresa.
Yes, it does suck. It makes be sooo upset to see all the handouts people are getting who are able to work, and then somebody like Samuel, who can’t do anything for himself is so neglected. I agree with Sylvia. Fox News or Glenn Beck, or Rush (can’t spell the last name) should read this one.
I love you sooo much!
Mom
August 25th, 2010 at 3:23 pm, Shari K. Says:
I second what Natalie said. I can’t imagine anything being more persuasive (at least on an emotional level) to the people at the insurance company than this blog entry. Including the pix! As for getting the media involved, I don’t know about those national news stations or people, but how about your local TV station and/or newspaper? As a former community journalist, I can tell you that we (or at least I) always liked being able to help folks in need by running a good human interest story! Hugs! I’m continuing to think/send all of you good thoughts!!
Shari in California
August 25th, 2010 at 4:13 pm, Darlene Says:
Some of the biggest flaws in the system is parents always having to fight insurance companies just to get such things as supplies,surgery,therapy,and medical equipment.
This is so wrong,they should be finding a way to give what is needed to help make their lives as pleasant and comfortable as possible. Instead of making it unsafe for them.
Another thing that bothers me is even with elderly nursing home resides being subject to move around from one nursing home to another nursing home whenever they are hospitalized for any illness when they are on medicaid/medicare. Why? They will only cover the expense for one but not the other,some even have been on their death beds. Why? Can’t they just have hospital hospice? Honestly,where is the dignity and respect when they are being tranfered around like they are moving boxes.
This makes me angry to see that Samuel has to have bruises like that on his leg/knee. Totally uncalled for in my book.
August 25th, 2010 at 8:39 pm, Allison Anderson Says:
I am willing to bet that if he ended up with a broken leg, you would be MUCH harsher than “I told you so”. I think these people do not understand who they’re messing with. Or whose boy they’re messing with. Go get ‘em, girl.