Tuesday, August 5, 2008

Curve ball

Ellie and Reid's mom in for a bit....

Insurance. Ahhhh....gotta love it and hate it at the same time. A little story for you all tonight. Today was a cruddy day to say the least. Thank goodness for my hairdresser whose daughter has outgrown her Barbies...and gave them to Ellie. They entertained Ellie all afternoon while I made phone call after phone call. Let me explain.

I carry our insurance for our family through my school system. We have had Medical Mutual insurance for years. When I became pregnant, we were on Med. Mutual insurance. We NEVER had any issues and all was well. July 1, 2007...our insurance changed. Mind you...I was 5 months pregnant and we switched carriers through school. We really had no issues. All worked out well. The new plan took care of the rest of my pregnancy and cared for Reid's medical issues. It was a fine switch. July 1, 2008...our district has gone back to Medical Mutual after issues with the "new" carrier that we had for the one year period. Ok....no biggie because we have dealt with them before. Well.....but they had not dealt with Reid. Reid was not born when we were switched to the new carrier. So, Medical Mutual hasn't had the privelege of carrying Reid on their plan. Ok...so on with my story.

I called our plastic surgeon's office today just to check in with a palate surgery date. We have been waiting for awhile now, and it is NOT like them to not contact me. So, I called in. They were so sweet and basically said that they are waiting on our insurance to approve the surgery and so on. A light bulb went on in my head.....they didn't know that our plan had switched. We haven't been to the p/s since June...on the other plan. I felt so badly and explained everything. They took down our info and so on. As the insurance gal from the hospital was going over everything with me she says....."I just want to warn you." And with those words...I thought I was going to be sick. I knew what she was going to say. She continued..."Medical Mutual is not in our network."

WHAT??????? You are a MAJOR hospital (not to mention the #5 children's hospital in the nation, the #1 children's hospital in the midwest) and they are NOT in Medical Mutual's network????? Ok....as I was stressing over these words...I was trying to figure out what this was going to mean for us....for Reid. I knew right there, that we were NOT going to switch our care. I don't care if I have to totally rearrange my life....I WILL NOT switch Reid's care. We know our doctors and nurses so well, and love them dearly. They are a part of Reid's life...and I can not sacrifice that. I won't.

So, I spent the entire afternoon on the phone to so many people trying to figure out where to go from here. (thank God for the Barbies! ) None of our doctors or specialists are in the network under our insurance. Unreal. Since we are in the middle of Reid's care with an upcoming surgery in Oct. or Nov., we have filed a waiver to see if we can still get coverage due to ongoing care that has already begun. We don't know what this will mean for Reid's long term care. I know for certain, I will NOT take him back to where we started. (go to Reid's cleft journey to understand where I am coming from if you don't know what I am talking about) For now, I am trying to remain calm and have a level head about the whole experience. If you talk to the many I talked to on the phone today...they will tell you what a mess I was. Ellie came over to me numerous times today with kleenex. Bless her heart. I couldn't even give her Mommy time today....I was too busy on the phone trying to get somewhere with this mess. I bet the insurance lady thought I was a piece of work. She asked me questions about our situation, and I just cried and cried to her. Poor lady! She must think I am a total fruitcake! Then, I had to call church for something, and our secretary is the SWEETEST person around. When I heard her voice, I was another basket case to her. I am thankful for all of you that are thinking of us and praying all will work out in the end. I was just hopeful to get some school work done today since I start back to teaching in 13 days. What a curve ball our family has been tossed. Somehow....we will get through this. It's just a little rough right now, to say the least. Thanks upfront for keeping us in thought. I will update you when I hear more.


steph said...

Oh, Janeen, just what you need...there has to be something that can be done with the insurance company. Did you talk to our school insurance rep? I hope that since you are in the middle of Reid's "procedure" they will reconsider. Hang in there, kiddo. I will see you soon. Hugs!

Grin & Barrett said...


You are in my thoughts..... .Please let me know if there is anything I can do.



Allison said...

I'm so sorry that this is happening. I can only imagine how you must be feeling. Please know we are thinking of you.

Good Remedy said...

Janeen, I am sick just thinking about this. You are absolutely right not to change your doctors/hospital. I found out that our doctors/hospital wasn't a preferred provider either, but that was at the very beginning, not after we'd begun. We were able to switch to another insurance company in time. I felt like that was a miracle. Take a deep breath and keep dialing! Can you add Reid to your husbands insurance, as a secondary policy? Just a thought. This whole insurance thing is awful!

Rachel said...

oh my goodness...that is terrible! i am so sorry you continue to have to go through things like this. you're in our prayers!!!

Big Hugs,


The Lucey's Triplets said...

How terrible, hopefully they can figure something out to help you guys out in this type of situation. I will keep you in my prayers! Hang in there!

Hello, and welcome to my page! I am so glad you are here. I am going to try and show you the average life of a 5 year old from my perspective. Mommy and Daddy will help me along the way if I get stuck.

Let me first introduce my family to you. I am Ellie. I am a 6 year old. I live in Ohio with my Mommy, Daddy, little brother Reid, and dog, Sophie. My mommy is a teacher. She teaches nine and ten year olds and loves it. She has been teaching for twelve years. My daddy works with computers. He works hard everyday.

We all love spending time together. I have wonderful grandparents and a terrific extended family. I am a very lucky girl. Thank you for visiting my page. Write to me any time. I love getting mail!!!

Many blessing to you all.

Little Ski (Ellie)

Mommy and me having cuddle time at Hocking Hills.

Told ya, my hair can be wild! And you thought I was kidding!

Hmmm, Blue's Brother's perhaps?