Thank you, thank you, thank you for all your offers of help and suggestions for strategic planning to make sure that Annika's care is still paid for. And I lapped up the sympathy like a kitty happening upon a spill of tuna oil.
Jörg has been all over this situation. He's in a good position, since he is the chair of the committee that negotiated the insurance plan last year. So he really does know the ins-and-outs of this area. The problem is that none of the contracts that we or the university were sent said anything about figuring yearly maximums according to the date billed, rather than the date of the service itself. This particular contract was made between our insurance company and a reinsurer, which is used to handle large claims, and we've never actually seen it.
Jörg did contact an insurance attorney, as well as the Illinois insurance commission and various other places. Basically he burned up the telephone lines tracking down every possible lead. And the answer always came back that since our insurance plan is a self-funded one, we basically have no recourse whatsoever. Whatever rules they make up are the rules that we have to follow, no matter how unintuitive they may seem.
Jörg also checked into Illinois public aid (that is the KidCares site that you sent me, Emily), and we only qualify for a "spin-down" program, since Annika has only used up her yearly max and not her lifetime max. This is the option I mentioned before, which will have a $2-3,000 per month deductible. A deductible like that will send us into some serious debt. But still, it's obviously better than trying to pay for a room at Children's on our own.
At this point, Jörg is still holding out some hope that the president of the university will be able to appeal to the board of trustees that administers the insurance fund (the funds are pooled from a group of universities). The hope is that they will just allow us to keep Annika covered through the year. We do at least have the feeling that the university and that our insurance company (not the reinsurer) are trying very hard to find a solution for us.
And Jörg just called to tell me that Children's is looking into re-running our bills with a higher discount applied in order to get our total back down under a million and allow us at least a few more months' coverage. It is
fairly shocking to think that we could have hit a million in the early days of February, even including bills from December. If we could get a few more months' coverage, we would at least have enough time to come up with a decent plan.
Jörg is looking at finding a job at our old grad school, Indiana University, for the summer and fall semester, just so that we could get new insurance to cover Annika until she can go back on his university's plan. This would involve taking an unpaid leave of absence from his current job. Thank goodness that he already has tenure, so that this is an option for us. Of course, this would involve selling our house and moving. And it's not even clear that that insurance plan would cover Children's, but at least it would give us insurance coverage until next January. Still, it's less than ideal.
So we're thinking this all over, and Jörg is getting very creative in coming up with options to get us through this without having to declare bankruptcy.
Finally, we have also looked into fundraising, particularly since it looks like our best option for continuing insurance coverage on Annika will eat up the majority of our monthly income, even before you include any of the other expenses of living at the hospital for months on end. I think that we will probably set up an account with COTA
, rather than just putting up some kind of a paypal button. First of all, this means that we don't have to deal with any tax issues since COTA is a not-for-profit (non-profit? I have no idea of the difference. See what I mean? I definitely don't want to be involved in any tax mess.) Secondly, they offer a lot of support to help us set up fundraising efforts, since we are absolutely clueless as to how to even begin such a thing. Thirdly, we like the fact that if we have donations go through COTA, there will never be any questions about whether we are using the money to fund a beachfront vacation for the whole family (although I do think I could make a pretty good case why such a vacation might be deemed medically necessary
). COTA disperses donated funds only for approved medical expenses. Finally, I like that COTA will use any donated money that is not used toward the funds of other children. It's hard enough to ask for donations, but it's nice to know that if the worst happens and we lose her, that the money will go to other children who need it. Is that a morbid thought? Am I just too tired to avoid fatalistic thinking?
Setting up the COTA account will take us a few days, as there is quite a bit of paperwork involved. But I'll link to it once we get it all up and running.
Again, thank you so much for all your wonderful support. I laughed so hard at the thought of contacting Michael Moore (suggested in the comments) with our little story of insurance woes. It's only sad because we were so confident that we had great coverage. Well, also because it happened so quickly that we didn't even see it coming. But the truth of the matter is that I have no doubt that there are insurance stories out there that make our tale of insurance terror sound like a veritable happily-ever-after fairy tale.
So, wow. Thanks to all of you who have commented or sent us suggestions of places and people to contact. And thanks also, unendingly, for kind words.