Steam coming out of my ears

[Wiped Out]

I feel like a cartoon character when you see steam coming out of their ears!
What a super frustrating day! We have difficult child's sleep study scheduled for December 1st. Some of you know we've been working on getting this since June.

I found out last Friday that our insurance company didn't approve it. Since then I've been working at trying to figure things out. Our company denied it because they said they can't prove his tiredness isn't related to his medications. Hello, that is not the main reason we are taking him in!!!!!!!!!

Ever since he was really little he has snored, it sounds like he stops breathing at times, he talks in his sleep, that is why we are having the study done. I remember when he was 3 his preschool teacher told me then she thought he had sleep apnea. A couple of years ago we had his tonsils and adnoids out. Didn't help.

We can appeal the insurance co. decision but will have to cancel his appointment.

Since difficult child also has medicaid through Katie Beckett I tried them. I was transferred several times-no answer. I called the sleep study place, they called medicaid who called me, who couldn't give me a definite answer but said they would call me today. You guess it-no call!

Today was another day spent on the phone getting mostly nowhere. I did find out medicaid will probably cover it but it needs to be preauthorized. Why didn't the sleep study place do that to begin with?

Basically we will have to cancel his appointment and reschedule. I'm tired of being on the phone (at least two hours in the past two days).

On the way home today difficult child said he wish I'd never been born, not a good thing to hear after trying to advocate for him all day. All I could think was why did I do all this advocating?

Did I mention too that my three difficult child students were extremely gfgish today?

O.k. thanks for listening to my vent-I'm beyond frustrated.

 

[klmno]

How frustrating! I don't blame you for feeling this way- let that steam keep right on blowing! It is beyond me why insurance companies and medical places wait until the last minute to decide and inform people whether or not something is approved. They have to know that people wait and schedule things around these procedures or tests.

I'm sorry you've had such a rough day and are having to deal with this. I would be ranting and raving to a lot of people on the phone- although it probably would just backfire on me.

 

[Andy]

Call the sleep study place in the morning. See if they can do a rush job for medicaid pre-authorization. They can fax in a request and get the results faxed back. Are they open on Friday? Medicaid may not be but even if they don't receive the autho until Monday morning. I would think they would not want to cancel this late in the game - With Thanksgiving weekend, it may be hard for them to find a replacement and if difficult child doesn't show, they loose big time also. If you do go in on Monday, insist on seeing any preauthorization in writing before going through with the study. Tell the study place you want a copy of that pre-auth.

So not fair! I so hate insurance companies. Why do they think they are more knowledgable than doctors?

 

[klmno]

Can you get a psychiatrist or regular dr to back you up and make some calls on difficult child's behalf, too? Stating that they think this is important?

 

[tiredmommy]

{{{Hugs}}} I can imagine just how frustrated you must be. I hope tomorrow is a better day.

 

[Fran]

Way too much difficult child type behavior intruding in your life.
No wonder the steam is coming out of your ears.

 

[witzend]

I hate insurance companies when they try to trick you out of your benefits. They are just hoping that you will give up before you get what's due to you and difficult child. It's rotten that you have to cancel the sleep clinic. It will be a very hard week to get ahold of anyone with the holiday.

I hope that you are able to set this aside for the weekend, and start fresh on Monday. It makes no sense to waste your time with peons. I would recommend that you inundate them with written reports as to the snoring issues. They'll use any perceived vagueness as an excuse to not pay a claim. I spent 8 months and dozens of phone calls trying to collect the hospital bill from when I was so sick in Mexico, and never was able to speak to a real person in the "international claims" department. Apparently, they "don't need phones because all claims are done by computer". Except they kept not processing the claim form I sent and saying that they had. I finally had to just re-start the claim. Then they processed it twice. Go figure.

 

[Jena]

I just wanted to jump in and say i'm sorry that happened and i can't imagine how aggrivating. When your looking forward to something happening and getting answers as usual and poof gone!! I'd scream. Than to handle kids all day and than hear difficult child say that!! Oh yea i'd be having a few moments in truck alone at end of day screaming. Ive actually done it a few times, try it, it does infact work

Good luck with this i hope you can figure something out so the test can happen.

 

[LittleDudesMom]

Sharon,

I see the steam! I agree with Fran - way too much difficult child behavior all around!

Hope this gets straightened out today. You didn't cancel already did you? I believe the clinic can get that authorization for you if they rush it. It is actually in their best interest to take care of this for you.

Sharon

 

[Wiped Out]

Thank you everyone! I already had them do a "Peer to peer" review with the psychiatrist. They still denied-they want to talk to the sleep clinic doctor who won't be in until Dec. 8th which is after the scheduled apt. I even called our union who often handles stuff like this, they said we could appeal but it would be better to cancel the appointment. and then do the appeal.

I will try calling the sleep clinic today to see if they can do any faxing. I also have a call into difficult child's caseworker to see if he can provide any help. I'm not too optimistic at this point but I plan to keep plugging away.

Witz-what a horrible insurance experience!

 

[SearchingForRainbows]

Sharon,

How frustrating and annoying!!! I would need to run for miles and miles and miles, etc., to calm down!!! I HATE medical insurance companies!!!
I know this doesn't help, but I've been in a similar situation and spent hours on the phone too. It SVCKS!!!

I have my fingers crossed that your "plugging away" will pay off!!! Thinking of you... WFEN

 

[busywend]

Yuck!

When you reschedule, put him on the call list for cancellations. As you can imagine, things come up and many times people have to cancel sleep studies. No babysitter for the other kids, child is sick, parent is sick, etc. It is hard to make it happen for many people.

Good luck with insurance company. It should not be this hard. Sometimes I think the high insurance costs are because they fight so many bills. They need so many additional people that spend so much time fighting charges, it costs us more in the long run. It is a horrible system.

 

[ML]

Thinking positive thoughts. I'm sorry you have so much gfgness to deal with right now. How exhausted you must feel. Big hugs ML

 

[Star*]

Just adding my support - Sheesh it's not like you just rolled out of bed and said - "Yup my kid has issues last night - I'll get him in for a sleep study tomorrow." is it?

sending pot holders for your ears.

Hugs

 

[Wiped Out]

Again, thanks for all of your support!

Well good news! I finally talked to someone that knew something. She did a lot of checking. Medicaid will cover it and no pre-authorization is needed. Apparently the person who told me that must have been generalizing because the medicaid difficult child has isn't connected to an hmo.

It was a lot more time on the phone but this lady was pleasant and helpful. Finally difficult child will have his sleep study done this coming Monday (knock on wood). We have been trying to set this up for months. We've been wondering about sleep apnea for years. It will be interesting to see the results.

WFEN-I understand the wanting to run for miles.

Star-rofl about the potholders.

 

[Nancy423]

glad to hear someone finally knew something!!! It's so rare in the insurance world eh? lol So all those hours spent on the phone actually worked!

difficult child had a sleep study at children's while we were on Medicaid, but that was so many years ago that things might have changed since then.


Good luck on the 1st