So, one of my summer projects was to convince our insurance company that they needed to pay for it.
July 21, 2011 - Insurance company received 16 pages of my packet (I mailed 21 pages.)
July 30, 2011 - "All 16 pages" were uploaded and imaged. Representative told me to call on Monday, August 8 and said that I would most certainly be denied but customer service could help me with my appeal.
August 8, 2011 - My "appeal hasn't been processed yet". The representative was going to "send a note over". She sent my receipts to claims and my letters to preauthorization. She said I "would be denied" because I "wasn't preauthorized". But she encouraged me to "always do a verbal appeal" and to call this Friday for the decision.
August 12, 2011 - My "appeal is not yet finalized". But my "request for authorization has been sent in."
August 17, 2011 - Our family goes on an outing to the Oklahoma State Capitol. I am reminded about the summer of 1991 when I went to Girls State in Texas. I recognize the fact that I live in a capitol city. A crazy idea forms in my head.
August 22, 2011 - I'm in the "processing phase...should be finished by the end of the week." And I get a DCN!! A Document Control Number!! So I can reference this at each call so customer service can be caught up to speed quickly.
August 26, 2011 - "Claim is in the ready status." What??? "Yes! We are cutting you a check for $235.50." Oh. What would that be for? Are you just paying a portion of each can of formula? "Hold please." Wait 9 minutes. "It seems to be that we are missing some receipts." I fax over missing receipts.
August 29, 2011 - 8:26am Insurance company received fax. They should be uploaded and imaged by August 30. Brenda the representative says "we will retroactively reimburse you and pay for formula going forward!!!" (Not just the $235.50 - which was one receipt but ALL receipts!!)Success! Elation!! Thrilled!!! Thoughts of Disney World pass through my head...
2:13pm Joe calls. "We have made a mistake." "Your claim is pending." "Formula is not covered." "Going forward we will not cover." "You have the right to appeal." "We will send you a denial letter." Tears. Sadness.
August 31, 2011 - Claim was officially denied. No longer pending. I have 30 days to appeal. If denied again I can take it to the "2nd level appeal". "Denial letter going out today."
September 9, 2011 - Have not received denial letter. Call insurance company. Tom gets Pharmacy Management on the phone. She says, "product service not covered." Why? I ask. "Well, we don't cover over-the-counter medicines." It's not over-the-counter. I have to have a RX. "I'm sorry. We don't pay for medically necessary food." Why? "Well, if a feeding tube is needed, then we would." Insurance company will pay for the surgery to get the feeding tube, the tube and the formula and any other necessary equipment. "There is no legislation in your state enforcing coverage."
September 10, 2011 - Begin appeal procedure.
September 12, 2011 - Hands are sweaty. Stomach is queasy. Feeling light headed. Scared out of my mind. Make a call to Senator Clark Jolley and Representative Randy Grau. Leave a message with both.
September 14, 2011 - Representative Randy Grau calls back and leaves cell phone number with Matt!!! I call Representative Grau back and leave rambling-horribly-scattered message on his voice mail....I'm not even sure I said, "Hi. This is Alyssa McCook." Oh yes...it was bad.
September 15, 2001 - Representative Randy Grau calls to see if Monday, September 26 would be a good time to meet. We have a pleasant chit chat on the phone. I am not at all rambly, horrible or scattered on the phone - what a relief! He goes to Quail Springs Church of Christ. Went to Edmond Sonshine School as a young boy. Went to Pepperdine. Took over representation from Ken Miller and was a page for Ray Vaughn. Loving the connections! Praying for a great meeting! I tell him that I would like to discuss the lack of coverage by insurance companies in Oklahoma for amino-acid based elemental formula.
So, until now....there were VERY FEW people that I talked to about my idea to get some legislation going on this.
And this is what I need from you, my blog friends:
1. Prayers - because really...I don't know what I'm doing.
2. High-fives. I'm collecting them. I think it will help my confidence.
3. Ears - I need to talk to as many people who will listen to my presentation (that I have not prepared yet) between now and Monday, September 26.
4. Connections to other food allergy people in Oklahoma. Please send your friends my way. Please send your friend's friends my way.
I'm sure over the next 11 days I'll make this meeting/event more public. I wanted to start here.
Thank you in advance.
11 comments:
Hey, I just spent some time in prayer over this. And I came back on the computer to see that you had changed your mind about #5!
I'm so impressed with your work so far and your documentation! We can't sit idle and expect God to solve our problems. We must take ACTION, too! High fives to you!
I will continue to pray for your efforts that potentially will affect many others!
I guess how much I missed you when you were gone to Girls State was worth it after all!
Alyssa, this is awesome!! You GO! I will totally support you in any way..prayer, listening, high fives...etc. Good for you..this is something SO worth fighting for!
Way to go Alyssa! I think this is the first update I've heard since we were bowling...you've been busy! I'm still praying, will listen and if you really want it, will give you a high-5 every time I see you :-) Our children certainly give us something to be passionate about!
Way to go, Alyssa!!! Rep Grau's sister and I went to camp together. In fact, I think I babysat him once. He's a good guy. Tell him hi, and good luck!
Good for you, Alyssa! I will pray for courage and wisdom and strength.
Sometimes don't you feel like you need to physically walk into the insurance company talk to them personally and move our documentation from pointe A to pointe B for them, so nothing gets lost or misplaced. Ugh!
Remember you are fighting for something your child needs. God didn't give you a spirit of timidity, but of power and love and discipline. 2 Tim. 1:7
I'm praying for you.
You ROCK girl!! Keep us updated!!
Well, we've already talked, so I won't take up space here on that. But on the "taking in trash" idea -- I think I see what you were thinking on that. And I think it's a good idea, except I agree about not taking trash. You've probably thought of this, but I'll say it anyway: Maybe you could use the computer to cut and paste pics of each of those things, and have them all on one page. Still a good visual, less bulky and trashy, something he can take back to the office, etc.
Also, his weight/ growth chart paired with when he started the formula would be good. Again, sure you've thought of this; but this has been much on my mind since last week too!
Still praying, and of course you can "present" to me! It'll be good. I know it.
(Have I told you that Ethan almost always prays to "help Jackson with his allergies" ? Caleb does too, sometimes; but Ethan almost always does. This might be SOME of that help he's been asking for, even though that's not really what he meant!)
My goodness you guys are so kind. I feel really encouraged by your kind words. I will keep you posted!
I answered your question in my comments in case someone else wondered the same thing. I also don't have your email address saved in my phone like it is on my computer!
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