Friday, August 05, 2005

Day One

Today was insane. I had to apply for MA for my son, beacuse our private insuance coverage ran out for his speech therapy. We got to the office ten minutes after they opened, only to be told we had to go to a completely different office on the other side of town. Well, that did not get crossed off of my list of things to do today. Maybe next week.

My daughter, now 15 months old, was born with congenital cataracts associated with Down Syndrome, and had her lenses removed at five and seven days old. Due to her age, they are unable to put in an implant because the eye grows so much it could tear. So, she has to wear contact lenses in order to be able to focus properly, and thereby develop as she was ment to. The problem that lies herein is that our private insurance will only cover one pair of contact lenses post a cataract surgery. That is of no concern to the average patient who is in their sixties. However, as an infants eyes change so quickly, we need to change the power of the lenses accordingly. Again, this allows for her to follow the developmental path that she needs. We are now on the third pair of lenses this year, and now the lenses are becoming more expensive, as she needs more specialized types. We thought perhaps, that the Medical Assistance that we have for her would pick up the cost of the lenses, since the primary insurance would not. However, as it turns out, neither will pay. Furthermore, once MA has been contacted, and has denied coverage, the billing physician or optician, cannot bill me. This puts us in a tough spot, because the physician who has already supplied us with the lenses is unable to be reimbursed. At this point the physician has informed us that he will no longer provide us with the lenses. We will have to find someone who is willing to work with us (essentially find someone who does not mind never getting paid for a product they will deliver, or paying full price ($400/pair) out of our own pocket). We have opted to pay the price, so as not to cheat anyone out of their livelyhoods.

I have contacted both the insurance company and our case worker, and after numerous phone calls to many individuals at various administrative levels, have gotten nowhere. I have also contacted the insurance commisioner in the state we live, to ask if there is anything they can do. They have nothing, although we will be filing a complaint regarding the first pair of lenses that the primary insurance has yet to pay for.

So I spent the better part of the afternoon chasing my tail in circles looking for funding.

After therapy, and housecleaning, dinner making and cleanup, I am taking two minutes to put my exhausting day to press. Quite the exciting life I lead. Time to take a long hot Bath, I need it.

On a lighter note, Little Peanut, As we call my youngest daughter, the one with Downs, did something amazing today. While working with her OT, she leaned all the way down, to grab something off the floor, while standing with support. This is the first time she truly reached out of her comfort zone, to get at a toy. She cried for a second, then looked up at me ( i was clapping and saying yay!,) and gave me ( and her therapist) the BIGGEST smile ever. What a great moment!

2 comments:

Naomi said...

Sorry you've had such a run around with funding. I hate the paperwork associated with medical stuff.

yay for your little peanut on reaching outside her comfort zone. it's those moments (that most parents never even really notice) that make all the hours of frustrations and therapy worth while.

Julana said...

That is great balance, Little Peanut! Good for you.

Having a chid with special needs is not so hard. Dealing with the system is hard.