Hi Maureen -
We're obviously both a little confused about who is trying to do what for our little girl. I don't think I need to point out how frustrated we are with this whole process in dealing with insurance denials. It was our understanding that you were only called BECAUSE the insurance appeals were unsuccessful for this formula. I know that's what the nurses at the Children's Hospital thought because they have called my wife on more than one occasion asking if we had heard any progress from your dealings with the insurance company. To be honest, we have grown accustomed to having to fight for our daughter to be allowed treatments and specialist visits; when the insurance company held firm with this denial, we tried various things recommended from the hospital staff:
Obviously, our neurologist sent in as many appeals as he could until they ultimately said stop bothering us.
I tried myself to contact the insurance company (both Anthem and CareMark) but was met with black and white plan coverage information.
I have spoken with my company human resources personnel, who "looked into it" just to decide that it was the insurance company's decision if they want to award services above and beyond what our plan covers. This is where we thought a Health Care Advocate such as yourself was stepping in to try and push the insurance company.
We've tried social security disability and found out that because I am employed, our daughter would not qualify until she was 18. It didn't matter what salary I had, as long as I was employed that was that.
We've tried other social services with similar results, never qualifying because we are above the poverty line.
I've even been in contact with a local Save the Kid foundation that would like to help, but since the hospital heard that insurance denied the claim, they have not moved forward with developing our daughter's specific nutritional plan.
At this point we're ready to just purchase this prescription formula ourselves without any financial assistance, even if it means falling behind on other bills. It's just unfortunate that almost everyone we have dealt with, while always sounding genuinely concerned or optimistic, still ends up treating our situation as nothing more than a paperwork trail. I know that Madison is our daughter and not the daughter of an insurance company or a doctor, but I would really like the day to come that someone treated her like a person and not a patient number.
I'm sure you have done what you thought you were supposed to do, but after dealing with these types of battles for over 3 years now, without an end in sight, a think we owe it to our little girl to get a little upset when it takes 2 or 3 weeks for someone to simply read a denial letter and say oh well. If there is ANYTHING you think I can try next, feel free to let me know. I for one have not given up on my little girl or this treatment.
Miles van Noordennen | Project Scientist
MACTEC Engineering and Consulting, Inc.
1090 Elm Street | Suite 201 | Rocky Hill, Connecticut 06067