Life as a Leach

Today I spent three hours working at my other job.  No, not as an ESOL teacher, although I worked 3 1/2 hours at that job as well.  The job I'm referring to is being Abby's personal assistant.  :) This afternoon after I got home from my paying job, I had plans to vacuum, mop, and clean bathrooms.  I vacuumed 1/2 of a room before the phone rang.  From there, I spent three hours talking to the insurance company 4 different times, dealing with two different service providers on two different insurance appeals we have filed, giving updates to our Model Waiver case manager, and emailing/calling CHOP multiple times because Abby's surgery date was changed.  Needless to say, the cleaning did not get done. I haven't shared about the appeals we have made, but they have both been very stressful and frustrating.  One involves us having to pay a large sum of money for Abby's medical care, and the other has become a federal case of fraud against our account (not...

The answer:   I don't know. The hospital where she is going to do the weaning just  told me today that they will have a bed for her.  I thought all of my worries were over and I could finally say that we were definitely going on Monday. Wrong. Turns out, they didn't put in the pre-authorization request to our insurance company until today.   This process usually takes three days before you get an answer.  Hmmm...today is Wednesday...uh, yeah, that would be FRIDAY afternoon  before I'm going to get an answer about whether or not Abby will be inpatient on MONDAY morning ....with Relay for Life, Father's Day activities, and volunteering at RMH in between. I have no idea why they waited this long when they were contacted a week ago about Abby coming in.  It seems to me that ball could have started rolling quite a bit sooner!! I called my insurance case manager (yep, they have case managers for the "special" policy holders who cost them a lot of m...

I'm way behind on posting this, but I have some fabulous news to share, in case you didn't hear it on Facebook...WE WON OUR APPEAL!!!  I was shocked that we found out as quickly as we did, considering they said it would be closer to a month and we found out in a week.  Apparently, the third party arbitrators deemed it so obviously in our favor that there was no need for them to mull over it any longer!  We're approved through May, which is when we would be up for reevaluation anyway.  We're hoping that they will move onto someone else and leave our family alone, but we'll see.  For now, we're covered!! Abby is pulling up on stuff like a champ now and has officially met all of her physical therapy goals that had been set for her...which were meant to be met by April!!  Go Abs!  We're going to meet to write new goals, since there's no rest for the weary around here. :)  Next up:  walking on her own! My parents are fostering a new Boxer nam...

Unfortunately, the MD Insurance Commission isn't able to help us because it doesn't have jurisdiction over our policy.  It's a private policy owned by the school system.  We're now working with the MD state attorney's office and have filed a complaint with them.  The woman I've been in contact with seems to really know her stuff.  I hope she'll be able to help. Right now, we are in a bit of a holding pattern because our appeal was sent to third party arbitration.  While I wish the appeal had just been met with a quick of course we'll approve your nursing, you sweet, hardworking people! kind of an answer, at least it wasn't a big red DENIED stamped on our file.  The state attorney's office has collected all of our information, but is waiting until we hear back from arbitration before they officially "begin" the case.  Arbitration could last up to a month....which will take us almost to our deadline.  Here's hoping it's done q...

Just so you know...we're still waiting for the decision regarding our appeal.  Our case manager said we should find something out by the end of this week, so I'm really hoping we do.  I've pretty much stopped being worried about it, because worrying won't help anything.  I'm just trusting that God is in control of this.  I know He won't abandon us and I really don't think that he wants us to be exhausted all of the time, so I think that something will work out.  Remind me of this at the end of February if we still haven't won our appeal!  :) So that's it...no news is good news, for now!

I haven't blogged about the drama we're currently dealing with, because I just haven't had time.  But to avoid keeping you completely in the dark (especially if we aren't FB friends), here goes nothing! I got a call on Tuesday afternoon from our insurance case manager (if you are a challenging case, they give you a case manager.  That's how you know you're a red flag!) and she told me that our nursing is going to be cut off at the end of February.  When I asked why, she told me that she was told that since Abby had a chronic condition and wouldn't get any better , they couldn't just keep paying for nursing indefinitely.  There are a whole lot of things that frustrate me about the situation, but especially that the medical director at the insurance company is off-handedly labeling my child as one who won't get any better...as if she is comatose in her home hospital bed.  No one from the insurance agency has ever met or even seen a picture of Abby....

We got some great news today:  our application for Model Waver has been accepted and Abby will be in the program!! Now, I am fully aware that most of you are going, huh? right now.  That's okay.  I had never heard of it either before Abby was born!  I have gained a whole new vocabulary in the last two months! Model Waver is a Medicaid program for children who have such big medical needs that they might not be able to go home without certain things in place (ie: private duty nursing and medical equipment).  It's pretty difficult to be accepted into the program because Maryland only takes 200 kids at a time....and once you're in, you're in until you don't need it anymore.  This is wonderful for us now that we're in, but not so great when you're on the waiting list. Fortunately--or not so fortunately, depending on how you look at it--Abby was put pretty high on the waiting list because of her vent dependency. This is pretty much why we were accepte...

I am convinced that the government made the Social Security application absolutely ridiculous in hopes that people would just decide not to complete it. I can just hear them now: Government official #1: [evil laugh] Hehehe!  Let's see how terrible we can make this form. Government official #2:  [rubs hands together villainously] Oh, yes!  Let's!  The more difficult it is, the fewer people will apply!  Then we can use the money we save the country on catered breakfasts for the staff! Government official #3:  Ooooooh, I have an idea!  Let's make them collect the name, address, and phone number of every single doctor the patient has ever seen!  Government official #2:  Great idea!  Then we can make them type each one in individually, even if they all have the same address!  [cackles] Government official #1:  Let's not forget that we need to require all of the medicines the applicant has ever taken.  If they're si...

To the right of the blog is a little button that allows you to follow me.  Please do!  I like to know who is reading...I'm  nosy that way.  Also, in order to comment, you have to be a registered user.  It's not hard to do, but the reason I have it set up that way is that I had a few anonymous comments that creeped me out a bit in the past.  This way, I can see who is commenting.  The positive:  I can comment after your comments if you ask me a question or say something I want to respond to!  Yay!  :) Tomorrow I have a big insurance meeting with my social worker and case manager to try to wade through an ocean of paper work, claims, policies, approvals, and other various kinds of red tape.  I will be spending my evening making sure I'm prepared!  It probably would have been easier if the social security, Medicaid and insurance phone calls I'd made (daily for the last week) had been returned, but I'll just have t...

A Day Full of Good News Okay, I just got back from from the hospital feeling more encouraged than I have since Abby was born. I must share! * Abby had her MRI today (she did great and didn't require additional sedatives) and we got the results. Everything they were checking for looks fine!! This is a huge answer to prayer. Yippee!!! * Her feeds will continue to increase until Wednesday, when she should be at full feeds!! (That's one ounce--not much to us, but plenty to fill a premie's belly!) * Tomorrow, they will begin C-PAP trials. This is a machine that offers a slight bit of pressure to assist the airway, but it will be done through her ventilator to avoid Abby getting into breathing trouble if she doesn't tolerate it. If the trials look good, then she will be put on this instead of the vent. When she gets off the vent depends solely on Abby, but it could be Wednesday! *There was concern about a blood infection, but the culture hasn't grown ...