Thursday, August 10, 2006

Out of the fog and into the light…

(A little background…John worked in a union before we started our company, and in doing so, he received full benefits for our family. When he quit his job, we began paying COBRA to continue our coverage until we made other arrangements.)

Fast forward to June 1, 2006…I received a certified letter from John’s union stating that there was evidence he was working non-union and so our benefits(which was actually COBRA that WE were paying for) were being pulled as of yesterday and they were sending our June check back to us. So there we were, for the first time EVER in our lives without insurance. Even on a normal day, the idea of no insurance freaks me out, but my son is due to have open heart surgery in a couple of months and in all reality, he could go into heart failure on any given day and have to have the surgery sooner. He also has a condition which has the potential to have major health issues and although none have shown up, you never know what the future holds. So there we were…immediate PANIC!

I immediately went online looking for a plan, and I cannot even begin to tell you how many plans are out there…in the zillions I think! So I went the route of an insurance agent who informed me that although John, Bella and I could get whatever we wanted, Jack will never qualify for any kind of Private Insurance because he has two pre-existing conditions – his DS and his heart defect. GRRRRREEEEEAAATTTT!!! Before I began falling to pieces, my agent reassured me that there is a state program out there for kids that doesn’t look at pre-existing conditions and it’s only $9.00 a month. Because we have a new business, we would qualify financially…Whew…or so I thought. Getting Jack qualified for this insurance has been my worst nightmare. First off, my “lovely” insurance agent did our profit and loss sheet incorrectly so that Bella was approved but because of her error, she qualified Jack to be referred to Medi Cal…First of all, there is no way in the world we qualify for Medi Cal, and secondly, even if we did, I want to choose Jack’s surgeon, not have it chosen for me. And it is impossible to even find a pediatrician who takes it. So I began the appeal process…I am surprised I didn’t have a heart attack after all of the stress these state workers put me through. Everything they asked me to do, I did it immediately because I needed insurance YESTERDAY! Every person I talked to gave me contradictory information which delayed the process each time. An example is they asked for proof of Child Support in the form of a letter from Keeley’s mom or the court order. I called Angie who faxed me the letter that day and I sent it to the insurance company. I then called them and restated what I had done and asked if it was sufficient. YEP…10 days later, NOPE! Sorry the letter isn’t valid. You need the court order and then it will take, yes, you guessed it, 10 MORE days to process. They made the mistake of getting on the phone with John when that happened and he flipped out on these people. They did an urgent request to expedite the decision…then they found something else we needed to do, then again and again and again…and every time it was 10 more days. I, in good faith did everything these people asked me to do and there was no reason Jack should not have received the same coverage as Bella. It’s so ironic that the person I needed to be insured the most was the only one I couldn’t get covered!

So I have been basically harassing these people, calling a few times a day to check the status and make sure I have everything in that I need to. A supervisor has NEVER been available when I call. I actually think they red-flagged us after John talked to them! I didn’t know the impact this has had on me until today…I woke up emotionally drained. I spent all day with a headache and just wanting to lay down and sleep it all away. I was exhausted! I was frantically worried about Jack. I had to pay cash for his well-check and I was willing to pay for his Cardiologist appt, but I have an awesome cardio who didn’t make me pay because he knows what hell this has been for us. I feel like this has been my job for over 2 months. Sometimes I have spent over two hours on the phone trying to get the right information and I’d run into dead-ends constantly.

So this afternoon I did my usual call to the insurance company and I was all riled up, ready to fight with them…but to my surprise, THEY FINALLY APPROVED HIM!!!!!!!! Halleluiah! I bugged them so much, they finally got him insured…It only took 2 ½ months! But OH MY GOODNESS!!! I am ecstatic! My baby is going to be taken care of and we don’t need to worry. Finally, a light at the end of the tunnel. I can’t tell you how happy we are! John said to me today to just forget about them and let’s find a different route and I told him that there was NO WAY I would let them take advantage of me and I would fight for what is rightfully ours. My son deserves to be insured and woooooo hooooooo, all this craziness was worth it!


Naomi said...

Wow, what a frustrating and long process. I hate all that red tape.

Glad to hear that you finally have everything sorted.

Anonymous said...

That's a great story. Waiting for more. » »

Lana said...

Frustrating indeed. I'm so glad that you have gotten insurance for Jack. My heart was pacing as I was reading your blog post. Unfortunately for us I have been looking for a way to get Lana insured for over a year now. I'm so emotionally drained that I've just decided to give up. There is so much more that I want to do to fight for her right to be insured, but for now, I just don't have it in me. Thankfully Lana is healthy with no scheduled surgeries or issues. Anyway, I just wanted to say "I feel your pain". I'm so sorry that you had to go through all of this, but I am proud of your for giving it your all. You go girl!!! ;)