Monday, February 16, 2009

turn that frown upside down

this story does have a happy ending, but...
this is how i've felt since october 29th in the late afternoon. 

october 29th is the day, a scant 36 hours before little m's scheduled cochlear implant surgery, that matt called me and said, "i have bad news. and it's going to be a lot worse than you think. surgery isn't going to be on friday. and it isn't going to be next friday either. it isn't going to be until april." i cried and cried; the insurance denial came just days after a personal natural disaster had hit my family, so the combination was completely defeating. it's hard to explain to someone who hasn't had a child with hearing loss or worked with children with hearing loss why it was so important for little m's cochlear implant surgery to happen before she turned a year old. the shortest version is that the window of time for language acquisition is small, and the earlier a child with hearing loss can get access to sound, the easier it is for her to acquire it.

i'll save this from being a really long and really boring blog post. over the next couple of days, we got in touch with the let them hear foundation, a foundation which, among other things, advocates on behalf of patients against the insurance companies. we had three chances for appeal: three strikes and we were out, essentially. amy b., our lawyer at LTH, took up the cause for us. she compiled a case using all of little m's files, and sent off the first appeal along with a massively huge 10 pound spiral bound book of cases, studies, and other data to the insurance company. 

appeal #1: denied december 11th. we were bummed, but kind of expected it. amy b. went at them again with more data, and little took some more hearing aid tests to bolster our case.

appeal #2: sent december 24th. and then...nothing. we made a placeholder surgery date for february 23rd, hoping and sort of just in case; our "real" surgery date was a week after little m turned one. our insurance had 30 days to get back to us, and there was just silence...until last friday. 

i called care allies, who is the liason between our insurance and us to get an update on the appeal since it had been a month already. "oh, that case was overturned on january 9th. surgery approved." i could hardly believe it- the surgery had been approved? the first week of JANUARY? so,

appeal #2: approved? not really. well, kind of. this began the flurry of phone calls, emails, and faxes that defined our last entire week...apparently, care allies never sent out that january 9th appeal approval. well, either that or they did and our surgeon's office, hospital, and matt and i all happened to misplace it. (highly unlikely if you ask me, since we were all on the lookout for this very important letter.)

once we finally got a copy of the appeal, we saw that her surgery had been approved, but with her old surgeon (Dr. S), who had since moved across the country, and at her old hospital (Children's in Oakland). let me tell you, the whole process involved loads of drama which won't translate well into this blog. suffice it to say, i spent all last week on the phone with care allies, during which i realized that they neither cared, nor were they my allies. 

there was a lot of passing the blame around, incorrect information, not very helpful "appeal specialists", and phone calls which involved me being very, very firm (and annoyed.)! i should mention that every time they correct or change the appeal, it takes 24-48 hours to get the revised version generated much less faxed or mailed out. so as the days disappeared and we neared the february 23rd surgery date, i was getting more and more anxious. we had to wait to see what amy b. at let them hear said every time a fax would come. every time we tried not to get our hopes up, which was good, because every time a fax came, it wasn't the approval we needed...let's just say it was a stressful week. (and i had to use my mean voice a lot. sigh. exhausting.)

monday & tuesday:
appeal #2 version one: surgery approved at the wrong hospital, wrong doctor.

wednesday:
appeal #2 version two: surgery approved at the wrong hospital, right doctor. (ok, getting closer, halfway there)

thursday:
appeal #2 version three: surgery approved at the right hospital, wrong doctor. (um, how did that happen?! they switched back to the wrong doctor, so still only 50% right)

friday:
appeal #2 version four: surgery approved at the right hospital, right doctor, but faxed to the wrong fax number!?

and then..finally, bilateral cochlear implant surgery approved with our right hospital AND right doctor AND on february 23rd!

we are thrilled! 
little m's surgery is in ONE week!!!! 
next monday, bright and early! 
as amy b. said, "well, it's not 6 months, but it's not 12 months either. not bad at all...10 months is 2 months better!"

(p.s. ok, sorry- maybe that was really long and really boring. gold star for getting this far!)

6 comments:

  1. So exciting to hear. Prayers of thanks, praise and success for you, Matt, and Monrovia.

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  2. FINALLY! amazing and beautiful news!!!

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  3. exciting news for little m!!!!

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  4. I AM SO HAPPY. I'm crying. tears of joy. we're there. stanford hospital and i are besties.

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  5. i still just got goosebumps.
    and um, i am a little faklmept right now.

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  6. not really long or boring. hallelujah. thinking of you often. xo

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