Tuesday, December 23, 2008

Why can't they make things a little easier?

I'm so frustrated right now.

We have been going through Early Intervention for all of Leah's therapy. Our insurance ran out after $3000, and anyone with a child in therapy knows that $3000 is not a lot, so we decided to use the birth-three state program. It has been working out really well for us. Through the state program we are in-clinic once a week and at home twice a week. We pay a minimum fee--which is so helpful!

So, with that said, we have been really getting moving on getting Leah's brace. Our PT assumed that since we had been going through EI, that we would do the same with the brace. UGH, UGH, and UGH! Going through the state to get the brace would mean waiting 3-4 months from NOW! We have been discussing this brace for over a month and I've had the script for well over a month! I had no idea that it was going to take that long, or I would have pushed our PT to get the ball moving a bit sooner! To top it off our EI case worker is as slow as molasses and she does NOT return calls--thankfully she is leaving and I will have a new case worker after the first of the year (pray she's halfway decent!). Ok, so now what? We get Leah casted for the brace, the PT sends off the paper work to the state, waits for the state, sends off the brace information to the company, company makes the brace and sends it back to us. Voila! Uhhh...not so much, the state takes forever to get back to us to authorize the brace! It's so frustrating. I've worked myself up to get this brace and now...we wait?

I asked the PT who came today, how long it would take if we just pay for the brace ourselves? She said 2-3 weeks!! That is a world of difference! How can I knowingly sit and wait 3-4 months when Leah could be wearing it in a matter of weeks? So, the kicker is the price--somewhere in the $350-$400 range. That's a lot of money! Especially, because this brace will only last for about 6-9 months!

I thought about going through the insurance company, so I gave them a call and they said that they would cover 80%, once our deductible is met. Well, we have not met our deductible--so they cover nothing.

I think what we will do, is buy this brace and then in about 6 months go through the state. Depending on what Leah needs, hopefully we can start the process early enough so that there won't be much (if any) time without a brace.

I just don't understand why things like this aren't a little easier? I mean thankfully, Leah doesn't NEED the brace immediately. Yes, she needs it, yes it will definitely help her...but it's not an emergency--know what I mean?

Those of you who have gotten braces for your children, what did you do? Did the state cover it? Insurance? Or did you bite the bullet, like us, and pay out of pocket?

I just can't wait 3-4 months, knowing that we could have had it sooner.


Popcorn House said...

We are lucky because we have gotten both of our braces a week after we were casted. And they cast when we see our rehab doctor. We end up having to pay out of pocket for his UCB insert for his right foot. It is about 200 bucks. I need to fight that some, but haven't been up to it. I don't see why we would have to pay for that if the doctor prescribed it. Seems weird to me.

Sorry that it is like that for you. I wonder why it varies so much per state. Let us know what you guys decide to do!

kara said...

We do not go through the state, I'm not even sure that is an option for us. We go to a local orthotist to have her casted and get the braces in less then two weeks. our insurance covers 80% no mater what. I know there are programs that help cover them, but I'm sure it would take just as long to do that as to go through the state. I do think it would benefit her to have them soon rather then later, Addisons has lasted 9 monthes for her, we just got her casted this last week, so we should be getting the new ones soon. Sorry I know this isn't much help.

Anonymous said...

Hi, Amanda,
More information on why the 'system' is so, er, poorly organized is one of my posts. You can find it - the top link under BB's opinions on healthcare, middle column.

Even though the first brace will need to be replaced, due to growth, after about 9 months, the effects of wearing the brace last much longer.

The screwy ways that state healthcare operates is frustrating, but you do seem to 'get it' for most of your circumstance. However, you might investigate or try to learn a bit more about the particular medical insurance plan that covers Leah.

Insurance routinely will not cover USBs or shoe inserts. Less costly shoe inserts are available from dafo.com.

Ellen said...

I know, it is so beyond frustrating.... We have successfully have insurance cover the braces. We have Aetna, and though I have to fight for therapies, they have been good about covering the braces.

Kiera Beth said...

Hi Amanda

We went through our private insurance and clinic and we had it covered with no issues (I just checked my statement to be sure!) We have been so fortunate with our insurance. I have a high deductible plan and we hit out out of pocket maximum within a couple of months of getting the insurance. Because of how my work benefits are, it is better for us to be on the high deductible plan and just plan on spending the out of pocket. I budgeted ahead of time for that money and then it will cover things like the brace without any hassles at all.

As you saw in my posts, they called us 2 weeks before Thanksgiving to set up a time for the fitting. We had it fit the Tues before Thankgsiving and picked it up 2 weeks later.

Is there a chance you would hit the out of pocket maximum next year (2009)? If so, you could get them at the beginning of the year.

I am not sure if that helps, but feel free to e-mail me off line and I can give you more details!