Wednesday, August 8, 2012

Health Insurance Case Manager and Therapy Update

Who needs sleep anyway? Blogging my health insurance situation is important enough to lose a few winks (or hours). Says the lady at 3am who will be quite the cranky person in a few short hours when she has to wake up!

Anyhow, Chianna had a therapy appointment today at 4:30. I was working up until the last minute, when I realized that her shoes weren't on and her hair was a tangled mess. So off I run to put her shoes on and comb our her tangles as quickly as possible without hurting her or pulling all her beautiful hair out! Then rush to the car, and rush to the therapy office, which is about a 15 - 20 minute drive. Rush in, to find that for the 2nd time in two weeks, her scheduled therapy appointment will not be happening because the insurance approval from Staywell hasn't come through yet! It has been 2 weeks! So I am upset with the therapy place because someone who was supposed to call me didn't; nor did they return my message yesterday when I called them to confirm the appointment either! At least, the occupational therapist that was there at the front desk offered to do some quick stretches with Chianna and showed me some new ways to stretch her that I really like a lot, so it was not a total waste, and I am so thankful for that!

So, I march off super, uber pissed off, doing my best not to take anything out on Chianna or let her even know I was mad because she doesn't understand these things and it will only confuse her. How do you hide this level of frustration? I do not know, I think I have perfected the smile through gritted teeth.

I get in the car and call my Staywell / Wellcare Case Manger, you know, the one that was none too helpful the first time around. But I figure, its better than some dimwit in 'customer service' [term used lightly] who will not likely even give me the correct information at all. And actually by dimwit in customer service, I don't mean any ill will or negativity towards any individual, they are only as good as the structure and policy around them, and when that makes it impossible to do their job properly, its hard to assume they should be caring and knowledgeable. Luckily, our case manager was on another call and the person who answered the phone in that department asked if he could help me. His voice alone was pleasant and comforting, so I thought I'd give it a shot. I guess, I have to look at it as what might be the silver lining in the situation - at least I hope it turns out well. He seemed like a big help to me. He is assigning me a new case manager, one who deals with long term therapy. (Yes, you can ask why didn't they do that in the first place? And also say "DUH" - loudly and obnoxiously, too.) He said that didn't make sense at all that they take so long to approve more therapy sessions when she needs constant care. I also explained to him the therapy problem I was having and that the previous case manager didn't really resolve any situation for me, because the place that she found for therapy is 45 minutes away and didn't have therapy available on the same days, but that even if they did that a 45 minute drive each way after school is too hard on Chianna both mentally and physically, and doesn't allow time for her school work, dinner, bath and bedtime. He agreed with me, and sounded much more empathetic and compassionate and understanding of my situation than the case manager they had assigned me did. She was just a strictly "by the book" type of thing and I was definitely upset about the lack of help. Hopefully this person I spoke with wasn't just a "yes man", because I've spoken with plenty of those type people at insurance companies before. And more importantly, hopefully the new case manager, or case nurse we are assigned can REALLY HELP us, not just give me lip service and quote their guidelines. Maybe they might be able to get her out of network therapy covered after all, maybe even they can get her orthotics covered out of network too, but if none of that happens, then hopefully at least we can get a steady stream of approvals so that when I finally get appointments for her to see her speech and occupational therapists, that we can keep them! It shouldn't be too much to ask!

I should be getting a call from a new case manager within the next few days, so as usual, I will try to keep the blog updated with the situation!

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