So you know that the baby Bubba has gross motor delays. They are minor minor minor – but he still has them…which is why we are doing physical therapy. (Yes, this is from his grade 3 brain bleed)….
Bubba has met every gross motor mile stone (crawling, walking and running) that has come his way….he just doesn’t necessarily do some of the things well. He still runs – and he’ll tell you he runs fast. But he falls. He falls if he gets distracted walking. (We call it ADOS- as in attention deficit OH SHINY!)
So – PT Christie thinks he really needs orthotics on his sweet little feet. This will help him not drag his toes or tip toe walk and run which will in turn – increase his balance and make him walk right.
She wants to put him in what is called an AFO or an SMO. An AFO is an ankle foot orthoses and and SMO is a supramalleolar othoses and it’s the smallest of the AFO’s.
I called the insurance company….known as an ugly word here in my house because I swear I feel like Matt Damon in the Rainmaker every time I call them…..
They said “ NOPE”, they wouldn’t pay for it…because those are used for hold wait for it….wait for it…
Like I have time to worry if one of my kids, much less the Bubba, has FLAT FEET!?
So here is the conversation with insurance girl after she tells me No…….
ME: Pardon!?!? – are you looking at my son’s history?
IG: Yes ma’am (so perky I could have smacked her thru the phone BTW)
ME: So you see that ya’ll’ve already paid like a ba-zillion dollars for him?
IG: Yes Ma’am…..I can see his history.
ME: He was a preemie, born at 28 weeks, weighed 2 lbs 12 oz and had a grade 3 brain bleed…do you see that?
IG: Yes ma’am. (she has such a way with the english language you know)
ME: and you see that he just had an MRI and saw a neurologist and he has PT once a week.
IG: Yes ma’am.
ME: AND YOU THINK THAT I’M CONCERNED THAT HE HAS FLAT FEET? REALLY? (YES, I was raising my voice at this point)
IG: I know, it’s frustrating.
ME: So…..what are we going to do about this?
IG: You’ll need letters of determination from his provider for us to reconsider anything.
ME: ya’ll are going to make this hard aren’t you?
IG: I’m sorry ma’am.
ME: Yeah right……– you’ll get them.
That was 2 weeks ago. So PT gets the letters from the neuro doc AND the pediatrician and SHE writes one. Total of 3 medical professionals putting in writing that Bubba NEEDS them and its’ not for flat feet!! Faxes it over last week, they’ve received it. But it can take 10-15 days for them to make their decision.
And, meanwhile, there's the client...
They're getting all these letters, some from Claims, some from Underwriting.
Most people give up.
And this, of course, is intended.
So I call again today
Me: Have ya’ll made a decision?
IG: (again, another overly peppy and perky girl) No ma’am. It can sometimes take them 20 days to make a decision.
ME: Y'a’ll told me 10-15 days last time.
ME: So what now. You realize ya’ll are holding up a 2 year olds ability to walk correctly – right?
IG: Im sorry ma’am. ’I’ll check into ma’am and can call you back. (enough with the ma’am beaacchhhhes)
So then overly peppy insurance girls calls back and leaves this message:
IG: We need to know what KIINNNNNDDDDD of AFO he is going to get.
So I call them back.
ME: What do you mean what KIINNNNDDD? Like the brand?
IG: I’m not sure, let me check (puts me on hold). We need to CPT code.
ME: Why didn’t you tell us that to begin with?
IG: I’m not sure – let me check.
ME: No, don’t. Ya’ll are making this very difficult. You have NO IDEA HOW MANY TIMES I’VE WATCHED the Rainmaker….You’ll get the code. BUT – if there is anything else that you are going to ask me for next week – can’t we pretend it’s next week and just ask me for it now?
IG: No ma’am. It’s this week.
Let's talk about this mysterious section U. Let's explain it to the jury.
Just read paragraph three.
"Claim handlers are directed to deny all claims within three days."
It’s so infuriating. But, I’m not giving in on this one. I waited for 25 months to get one thing straight with this sweet boy of mine….I’ll fight another 25 months if I need to!!!
Every lawyer, in every case, crosses a line he didn't mean to cross.
It just happens. And if you cross it enough times, it disappears forever.
Then you're nothing but a lawyer joke.
Just another shark in the dirty water.
Same thing about the dang insurance companies…
Oh and by the way…I’ve scheduled my boob squishing for November 28th…have you scheduled yours?