One day Anni was twirling and singing one of her original compositions.
"It's my gift!" she declared.
Dizzy, she fell with spectacular gracelessness.
Laying on her back on the tile floor she began flapping her arms and legs
as if she were making a snow angel.
"Falling down is also a gift!" says she.

Thursday, February 09, 2006

we are so screwed

Oh, yes we are. Due to some unexpected insurance maneuverings, we are very likely to run out of insurance coverage. On Monday. Annika has a 1 million dollar yearly limit on her coverage. Although we knew we were racking up bills at an astonishing rate, we thought we were OK because a good portion of the expensive stuff happened in December. So we figured, naturally enough, that we were starting over with a new limit with our January stay. Jörg discovered today that our insurance company, or more precisely the insurance company's reinsurer, figures its limits according to when the bill comes in, not when the service was actually rendered. And, somehow, many of November's and December's bills didn't roll in until January. So that's it. We're out of money. And it gets even better. Jörg checked into what sort of state or government assistance would be available for a child who ran out of insurance while still in need of serious medical care. It turns out that we aren't qualified for anything that costs less than 3,000 dollars a month (plus our usual premium for the university's insurance), mainly because what Annika has reached is a yearly limit, not a lifetime limit. So she's technically still insured. It's just that insurance won't pay anymore this year. I'm looking at the calendar right now to remind myself that, yes, it really is only February. Holy crap. As if we weren't already broke enough, what with the millions of incidental expenses that come with long-term hospitalizations. This was totally and completely unexpected. But on the plus side, it's mobilized my anger and all that emotion away from mulling over the uncertainty of Annika's future health-wise. It's much easier being angry at an insurance company than at the nebulous workings of the universe that have led Annika to have so many problems. It's crazy. And we are flabbergasted. I know most transplant families do fund-raising, and we never did that, thinking that we were fairly well-cared for, insurance-wise. I do know that people at Jörg's university are working as hard as they can to try to help us, but I'm not sure how much they can actually do. I say again, it's crazy.
~~~~~~~~~~~~~~~~~~~~~~~~
Annika, meanwhile, is doing very well. She started eating real food this morning, and is very pleased with the feeling of a full tummy again. She had a breakfast of peanut butter, wheat crackers, and carnation instant breakfast. But she was campaigning hard for chocolate cake. So, for lunch, chocolate cake it was. On the down side, she vomited yesterday and she's got some seriously stinky stuff coming out the other end at a rather brisk pace. She's being checked for C-diff and rotavirus and all the other usual suspects, but no leads on that as of yet. She's been a bit more perky today, what with all the regular food offering a serious pick-me-up, although she's a bit irritated that she's still getting the TPN (IV nutrition). "But I'm eating now, Mom! Through my mouth!" And her spunk has been showing up at unexpected times. When one of the residents came to examine her, she let her know in no uncertain terms that she was ready to get out of this room. "Where do you want to go?" asked the unsuspecting resident. "Back upstairs. To 6. To the blue-and-yellow rooms," answered Annika unhesitatingly. "Why is that?" she asked, curious to hear a 5-year-old's take on the subject, I suppose. Annika gave her a withering look, full of pity for the obvious inexperience that must inform such a question, and answered succinctly, "Because this is the PICU." A-ha. Say no more, child.
~~~~~~~~~~~~~~~~~~~~~~
So after the venting of my fears in my last post, or perhaps because my anger about the insurance situation has ignited my better spirit, it seems my capacity for optimism has returned. Maybe Annika will stop bleeding every few weeks. It could happen. Or maybe she won't, and we'll be forced into a retransplant to try to save her life, and maybe she'll pull through it OK, after all, despite all the indications that would make that scenario less likely. As Dr. Emerick said in rounds the other day, "This is Annika. She takes a lickin' and keeps on tickin'." I have appreciated hearing all the stories of miraculous surgeries from others, and also the gentle advice that we seek another medical opinion, but in some way I really feel that we are bound to stay here, at Children's in Chicago. The fact is that no one has said to us that bleeding from Roux varices is a particularly inoperable condition. In fact, the Rex shunt that she was originally scheduled to have, and which did not work due to her complicated anatomy and tendency to bleed, would have solved the Roux varices issue. And there are other shunts and other surgeries (devascularizing the Roux limb, for example) that could also solve the issue. The problem is that the surgeon does not feel that any of those options would be a good idea for Annika. And it's not as if we are depending on the opinion of some unknown, untested surgeon. Dr. Superina is well-respected and very senior in the field, and he has undoubtedly performed more Rex shunts than any other surgeon in this country. And it's also not as if we are depending on the opinion of a timid surgeon unwilling to try difficult surgeries. And although another surgeon might think that some sort of surgery might fix Anni's bleeding, Dr. Superina is the only surgeon on the face of this planet that actually knows what Annika looks like there inside her complicated little abdomen. No non-invasive imaging technique in the world will really tell anyone whether or not a particular surgery is likely to be a success or not. If Dr. Superina says that he doesn't think it is a good idea to operate, then I think we would be foolish to choose the opinion of someone who could only look at a cloudy image over that of the man who has actually shaped her internal landscape. All that being said, I would love to hear, Mary Lee, exactly what kind of surgery helped your daughter. Just to make sure that it's not an option that's being overlooked, although I do feel certain that she is not a good candidate for any type of surgery whatsoever for several months at least. E-mail me!
~~~~~~~~~~~~~~~~~~~~~~
So it's off to pack up our stuff to move upstairs, back to 6. We'd rather be heading home, but at least the rooms are cheaper up there.

52 Comments:

Blogger moxiemomma said...

so, now's the time to start some fundraising. anyone have any good ideas on how to do this most effectively? i know about Drop Cash and people can donate through paypal, but it would be best if it went straight to moreena. moreena, would you be open to starting a drop cash campaign? everyone could link it on their blogs.

hopefully joerg's university will get things straightened out with the insurance company, but in the meantime this could be a stopgap measure. i know there are probably hundreds, maybe even thousands of us out here who want to help in some way.

2/09/2006 7:38 PM  
Blogger Sarah said...

As if you didn't have enough to deal with. Insurance crap stinks. Well, I am glad to hear that Annika was able to eat, and chocolate cake!!! How exciting!

2/09/2006 8:02 PM  
Blogger liz said...

What Moxiemomma said.

Big hugs to that Annika-girl and save a slice of chocolate cake for me.

2/09/2006 8:29 PM  
Blogger purple_kangaroo said...

Moreena, if you are going to do fundraising I would like to donate a handmade item (perhaps a quilt or a crocheted blanket) to auction or raffle off, if that would be helpful.

2/09/2006 8:33 PM  
Blogger susan said...

Oh no. How crazy.

Not that you wouldn't have thought of this first, but any chance of fighting the insurance company's determination of the allocation of expenses to years?

I thought words had failed me at your last post, but this one...how awful on top of everything else.

2/09/2006 8:33 PM  
Blogger corndog said...

Yay for Annika feeling better!
Yay for getting out of PICU!
Yay for chocolate cake!
Boo for the insurance company!
Yay for people who want to help!

2/09/2006 8:58 PM  
Anonymous Anonymous said...

I'm sitting here just shaking my head...insurance companies...they stink stink stink.

Glad to hear Anni's spunk is back now and then...continued prayers.

2/09/2006 9:00 PM  
Blogger Elizabeth said...

Oh. My. God. I'm so sorry.

Before we start holding bake sales, I recommend you find someone senior in the hospital billing office to talk to. Among other things, they know that you're not going to be able to pay another $1 million or so out of pocket, so it's in their interest to find another way for them to get paid. Frankly, they'll probably be thrilled if they get 10 cents on the dollar. Moreover, if they caused the problem by screwing up the billing, they should be responsible for helping fix it.

Second, you should talk to a bankruptcy lawyer. I hate to be the voice of gloom, but there's a real possibility that you're going to wind up going bankrupt to get out of these debts. (Medical bills are the #1 reason for bankruptcy in the US.) You want to hold off as long as possible, since you can only do it once. And a lawyer can talk to you about the state laws, and ways that you might be able to shelter your house (if you have one) and retirement savings.

Good luck.

2/09/2006 9:01 PM  
Anonymous Anonymous said...

Can you BEG the hospital to submit any new insurance claims in late December of this year? So it wouldn't pile up?

If only it were that easy...if only they'd do it for your family...

2/09/2006 9:04 PM  
Blogger Yankee T said...

Totally ridiculous. Outrageous, even. I'm glad she's feeling better, and I wish I were a millionaire.

2/09/2006 9:41 PM  
Anonymous Jamie said...

My word.

I always pop in here hoping for good news. I'm glad Anni is eating and moved out of the PICU. I'm so bummed for you about the insurance. Really bummed. What else is there to say?

If there is anything at all I can do to help, donating items or just anything at all. Please let me know. We're in IL now (moved a couple weeks ago) so any help dh and I can provide, we will.

Months ago you left a comment on my blog that I really needed to read and I haven't forgotten that kindness at a much needed time. So, really, anything I can, I will.

2/09/2006 9:42 PM  
Blogger candace said...

I'll never forget the day when Mark came home from work and said he'd been in a meeting about the company's insurance. They had to change companies. Because of HIM. Because of his transplant! It really put things in a different perspective. I have been reading the updates, and regret that I have not been commenting. I simply just don't know what to say and can't find any of the right words. So, instead, I pray. It's something new for me. Love to you, from our family to yours.

2/09/2006 9:59 PM  
Anonymous Anonymous said...

Damn those insurance co. don't they realize that when people have these types of health problems that they need to be a little bit nicer....don't we all wish..it will never happen.
Anyways...happy for Annika feeling better, getting real food and especially cake. I look forward to getting an update from you everynight..and then I pray for a better tomorrow for you all.
Hope you find peace with Ins.stuff, and I will check to see if there are any fundraisers going on.
Hugs to all,
colleen (spencers gramma)
P.s. Your Dr. sounds like someone I would trust with my child anyday.

2/09/2006 10:22 PM  
Blogger parodie said...

I can't believe it. Seriously.

I'm so, so sorry you need to deal with this on top of everything else. Unbelievable.

2/09/2006 10:25 PM  
Blogger Laurie said...

CRIPES. WTH? This might be super lame sounding to you, but I sell jewelry. I would be more than happy to hold a fundraiser, perhaps with your blog friends, or in the hospital or whatever, and I'll donate all my profit. If that interests you, email me at blingmommy@gmail.com. It's not going to go into the millions, but it might net a few hundred. I want to help.
ANNI. YAY for YOU getting to go up to 6!!!! Blue and yellow ROCK!
Hugs to you, you lil stinker!
M~ Always, prayer. Thoughts and prayers.

2/09/2006 10:53 PM  
Anonymous Joanna said...

Oh gosh, Moreena, what else!! Good advice from Elizabeth, find someone high up in the hosp billing and create a stink. I'm so happy that Annika had some choc cake, it's a wondrous healer and I'm happy that you're getting a break from the PICU. So let us know what you need us to do and we will do what we can, because you're already doing all you can.

2/10/2006 1:19 AM  
Anonymous Beanie Baby said...

God. An insurance mess on top of it all. That is just so fucked up.

I have absolutely no idea of the workings of the US health care system, so I'll just nod my head wisely to those who do, and add one thing:

If it doesn't work and you're going to be screwed, you have a lot of people out here pulling for you who won't let you go under. You are not in this on your own. If we need to, we will hold the internet fundraiser to end all internet fundraisers.

2/10/2006 6:28 AM  
Anonymous Anonymous said...

Let me add to the offers to help.

There are some good suggestions here - check those out.

I'm so happy to hear of improvement and that Anni's moving back to 6. And that's she's eating. SMART GIRL!!! Chocolate cake would be my choice too.

((HUGS)) to you both ~

tina

2/10/2006 7:10 AM  
Anonymous peripateticpolarbear said...

What's wrong with chocolate cake for breakfast? It has eggs in it!Glad she got it for lunch, and am completely dumbfounded at the insurance situation.

2/10/2006 7:27 AM  
Blogger CLMama said...

I would completely contribute to a fundraising effort, Moreena, for whatever I could be worth. I think of you guys daily and am praying...

2/10/2006 8:00 AM  
Anonymous Stacy - Tanner's mom said...

Hey Moreena -

I know you are a vetern at dealing with insurance companies, but I'm going to through $0.02 in here and hope it helps.

If your copays & out of pockets are based on a yearly cycle (01/01 - 12/31), then I think it's safe to say that your yearly limit would also be based upon that same cycle. I know that "reinsurance" can be a bitch - we had to deal with it for Tanner's transplant and it caused us nothing but headaches (including the hospital coming to us on his last day inpatient and telling us that we werent' covered because we weren't preapproved for the transplant - UM YES WE WERE). If your insurance had changed on 01/01 - it's not the new insurance company that gets billed - it's all based on date of service (usually the first day if you go in the hospital and it bridges into a new plan year).

I'm hoping someone inside the University can raise a little hell and get it straightened out. It's amazing what they can do that we cannot get done. What about a state insurance commissioner? Sometimes they can have some useful insight on this sort of stuff as well.

I'm glad Anni is feeling better!

2/10/2006 8:07 AM  
Blogger Laurie said...

Moreena,

I've sent you an email regarding your insurance problem. I hope I can help.

I've fought for a lot of things with Anthony's insurance company and mostly won.

What a rough thing for you to have to deal with when all you want to concentrate on is getting Anni well and home.

PLEASE let me know if I can help.

2/10/2006 8:12 AM  
Blogger Laurie said...

Oh, and if the insurance company "wins" this fight, be sure to file a complaint against them with the insurance commissioner's office. I've been there and done that, too.

2/10/2006 8:15 AM  
Anonymous anni metz said...

what a glamorous christmas picture you put up on wednesday! i hope annika starts feeling better soon & that room #6 treats you kindly.

2/10/2006 8:20 AM  
Blogger Phantom Scribbler said...

What Beanie Baby said. If you can't make headway with the insurance company, we are going to have the internet fundraiser to end all internet fundraisers.

2/10/2006 8:44 AM  
Blogger Badger said...

Moreena, I am so sorry to hear this all-to-familiar story.

You know, Michael Moore is making a new film about the health insurance crisis in our country. Maybe the threat to bring him in to document your case would light a fire under the hospital and insurance company. ;)

2/10/2006 9:14 AM  
Blogger Badger said...

This comment has been removed by a blog administrator.

2/10/2006 9:16 AM  
Anonymous Lauren said...

I'm definitely helping with fundraising, too! I'll start looking into the most effective way to raise money quickly~

Love and Prayers,
Lauren

PS I'll make a chocolate cake when I visit Anni next!

2/10/2006 9:21 AM  
Anonymous Lisa V said...

I agree with the above comment about learning how to protect your financial assets now. My mother was able to "homestead" her house, when my step-father had a medical crisis. It will protect your house from debt collectors.

2/10/2006 9:24 AM  
Blogger Lawmummy said...

DON'T run to a bankruptcy lawyer. That won't help your current situation.

But, speaking as a lawyer (albeit a tax lawyer), I highly recommend that you seek out an insurance lawyer. If you can't avoid to pay, try legal aid. There has to be an answer and I don't think it should be you and your husband dealing with this kind of crap when you have far more important things to worry about.

If you want to email me, I would be happy to dig around in PA and see if I can find someone who can recommend someone to help. Let me know.

2/10/2006 9:29 AM  
Blogger Rebecca said...

It sounds like you have a legitimate argument against the insurance company: medical care is always covered based on the date upon which the care took place, not the date upon which the company received the bill. I think they're just trying to jerk you around so they can save a few bucks, and its SICK that insurance companies prey upon the people who can least afford it.

I don't know if you live in Illinois but your hospital is in Illinois so this might be worth a shot. The Illinois Division of Insurance (state regulator) is REALLY AWESOME and they will strongarm your insurance company into submission on your behalf, provided that they are a company doing business in Illinois, at least. You can even submit a complaint online. When we lived in Illinois, I went to them TWICE on behalf of my mentally ill husband (again, let's pick on the folks who can't fight back!) and the minute they get the complaint, they act on it. They got his notoriously evil health insurance company to shape up, just with a simple letter. Those people are great and I strongly urge you to take advantage of their ability to make insurance companies do the right thing (if applicable). If you don't live in Illinois, I'm sure that your state has a corresponding regulatory division.

2/10/2006 9:32 AM  
Blogger Mike said...

I'm trying to imagine what it must be like to be the underpaid schlub who works for the insurance company trying to find ways to screw parents out of coverage for their sick kids. Ugh. I can't imagine what that'd do to their soul. It must be shriveled down to the size and shape of a currant.

Maybe I've watched The Incredibles too many times.

2/10/2006 9:42 AM  
Anonymous Becca - momofnataliebear said...

We will continue to pray.

I think that everyone here has given some good advice.

God Moreena, I feel like my heart is being ripped apart for you.

Talk to Renee Shores (transplant finance person at the hospital - she rocks) also ask the hopsital about COTA (www.cota.org) Children's Organ Transplant Association - CMH was a founding member.

Let me know what you need. And I'm totally serious. Anything.

We will be there on Thursday again for another CAT sccan.

2/10/2006 9:57 AM  
Blogger Jane Dark said...

Oy. I'll be in on the fundraising; believe me.

Glad that Anni is feeling better...

2/10/2006 10:26 AM  
Anonymous Rowan said...

I have often cried when reading your posts. This time it is hot tears of anger. You can't be the first people that this has happened to at Children's Chicago. Surely, The social worker has someone that you can talk to to brainstorm ideas.

If there's anything I can do to help...I don't know what it would be, but if there's anything - at all.

2/10/2006 10:54 AM  
Blogger DaniGirl said...

Moreena,

I just found your blog, and your beautiful daughter's story, via Phantom Scribbler. I'm appalled at what you're going through, and wanted to add my voice to the chorus of support. My dad had a liver transplant three years ago, but I can't imagine what you and Annika have gone through.

2/10/2006 10:58 AM  
Blogger halloweenlover said...

I am outraged. OUTRAGED. Funny that as a lawyer my first thought was like Elizabeth's and Lawmummy's- find a lawyer, insurance and bankruptcy. Damnit, you will not be expected to pay these bills. That sounds like some shady dealings on the date of service vs. date of billing. Let's hope this is just some nitwit that is making a mistake. You do not need this right now.

I am happy to hear the optimism, though. And that Anni is feeling better! Sweet girl, she deserves a whole chocolate cake!

2/10/2006 10:59 AM  
Blogger Scrivener said...

Just speechless at the insurance company. I mean, I'm not surprised that they would try to screw you like this--insurance companies are, after all, utterly evil--but for you to have to deal with this on top of everything else. I'm in with whatever needs to be done to help.

2/10/2006 11:02 AM  
Anonymous Lisa (Aiden's mom) said...

Moreena,

This really crazy.

I wondering if they can make you a "charity case"??? I know in Atlanta they can take a few of these a year, where the hospital "eats" the bills.

It seems almost like they HAVE to do a few a year due to donations and grants or something. I just know some of this was discussed when haley was getting listed and her insurance also cared more about the $ than the child.

I am SICK about how our government will actually PENALIZE children and their families because they are sick. If you were in the right socio ecomonic group it wouldn't be an issue, but instead you have a sick child and you HAVE to work to keep insurance cause a lack in coverage TRULY would be the worst most awful disaster.

OK I am sorry I am rambling on your guestbook.

I am SO glad for the chocolate cake.. I second that and think I will go have a peice FOR Anni.
I am so just sorry that all this happens. We are thinking about you all the time. ((HUGS))

2/10/2006 11:05 AM  
Anonymous Sheryl, Justice's mom said...

Well, new ball game on more than one front it sounds like. I agree with many, sounds like it's time to set up fundraisers although I will throw my two cents in as well. I'm glad we went non-profit. No tax headache with what was donated. We went with NTAF. They were a great support and helped with things like media releases and other big functions that could generate support fast.

In the mean time, get HR and medical billing talking because that sounds like absolute crap. You have more important things to be worrying about than insurance billing, especially when the next round of procedures is still undecided.

Besides, as Lisa said, every hospital eats a few bills a year. Anni's case is special, it's worth looking into.

We'll help any way we can. I'll even put aside my pregnancy crazed cravings for nachos and eat chocolate cake in Anni's honor!

Glad you guys are out of PICU...

2/10/2006 11:17 AM  
Blogger Amanda M said...

One strategy with insurance companies I've seen work before is to go over their heads, to go to the top. Make friends with someone in the governor's office. Work all the connections you have...I'm sure that through the university there are some connections with local politicians. Heck, the university's development department has to know, as will the deans, etc.

Two examples: When Katie was having problems we had a friend who is a state senator talk to the insurance commissioner and it was all fixed. With one phone call. Just like that! Things aren't supposed to work that way, but they do.

Same thing with another little girl in Alaska who desperately needed a liver tx and couldn't wait the 8 -12 weeks it would take to get TEFRA approval - someone in the governor's office pulled strings, that kid got her tx and she's doing well today.

Just an idea, just brainstorming....but a lot less work than a lot of fundraising....really, it's just a simple issue of a matter of dates, right? Not such a big thing that a stroke of a pen or computer couldn't fix it....if the right person gives the order...

2/10/2006 11:41 AM  
Blogger Marc said...

Moreena,

It's my first visit to your blog. I read the transplant story and a few other posts. And I cried. At my desk at work. All I want to do now is go home and hug my 13-month-old daughter. I can't imagine going through everything you have gone through.

When I was in college, I danced in Penn State's 48 hour Dance Marathon. "THON" raises money to help families of kids with cancer at the Hershey Medical Center. You and your husband both work at a university, right? Perhaps that could be a good fundraising source. I'm sure there is a fraternity or some other student organization that would take up your cause and put together a fund raiser.

2/10/2006 12:02 PM  
Blogger Rana said...

I don't know what to say, except that I am sad and angry on your behalf. How utterly aggravating and frustrating and stressful!

2/10/2006 12:35 PM  
Anonymous kathy a said...

dear moreena --

i have lurked a few times, and am so very sorry about what is happening. the insurance saga is just over the top...

many people have given good advice about dealing with the ins. co. and working with your hospital. and trying to protect your assets.

as for fundraising -- a lot of people really, really want to help. i don't think you can possibly deal with setting up fundraising, but i hope you will accept these expressions of goodwill. there is a discussion of how to help over on phantom scribbler's: http://phantomscribbler.blogspot.com/

the main thing you would need to do is set up some kind of special account with a bank, so those who support anni and your family have a place to send gifts to help with medical and related expenses.

hugs to anni, and to you! it is great she is doing better.

xoxoxoxoxo

2/10/2006 2:01 PM  
Anonymous peripateticpolarbear said...

Just a note to let you know that Phantom Scribbler is hosting a discussion for how to raise money on her site (which is a very cool site anyway, complete with Wednesday whining). To join in the fundraising convo, surf over to her place:

http://phantomscribbler.blogspot.com/

2/10/2006 2:44 PM  
Anonymous Genevieve said...

Moreena, I sent you an email about the insurance issue - I have some knowledge in this area and would very much like to help.

2/10/2006 3:04 PM  
Anonymous chasmyn said...

Oh my - that is so scary about insurance, and bullsh*t!!! WTF - they go by when it's billed? That is insane. Insane!!! Definitely start some fundraising, I'll link to it.

I'm glad you're moving out of the PICU - and its good to know Annika is feeling like herself sometimes. What a little superhero you have there.

2/10/2006 3:28 PM  
Blogger Kathryn said...

Oh dear Lord! Cannot believe that you now have this to deal with...Can only echo the words of others, hoping and praying that there will be some way round the insurance crisis, longing to help in any way that I can, and relieved that Anni is able to eat, and hopefully in the blue and yellow room safely by now.
What a ghastly week.
I did light a special Anni candle in St Mark's in Venice...there was a rather comfortable looking statue of Mary cuddling Jesus, and she looked for once like a real mum, someone it would be good to have around if you were poorly...Not usually very into her, but this time it felt OK to ask her to join in cheering for Anni's side.
Ongoing love, hugs, prayers and thoughts of chocolate cake! xxx

2/10/2006 3:52 PM  
Blogger Brenda said...

Oh my hell, as if you don't have enough to worry about.

So sorry!

2/10/2006 5:31 PM  
Anonymous Gerilyn said...

Moreena,

A member of our church needed a heart transplant and was faced with a similar stroke of unbelievable irony. The VA said the transplant needed to be in Madison, WI (a fine place, but not very close to Minneapolis). His wife was struggling from life threatening cancer and they needed each other.

Endless calls and letters to local politicians from friends, church members, etc. yielded nothing. Someone from our parish contacted the Mpls Star & Tribune and a columnist wrote this article:

http://160.94.9.156/ahc_news/121503/Couple%20Need%20A%20Dose%20Of%20Understanding.htm
(if the link doesn't work, its the first hit on google if you type in "Craeg Nolan").

That got the attention of the politicians who arranged to let Craeg have the transplant in Minneapolis at the U of M. He's doing well now.

My point is that I think sharing your plight with media outlets could help 1) with fundraising efforts and 2) potentially pressure the insurance company to realize they are dealing with people's lives - not just the bottom line.

Good luck to you and I'll keep checking back for the COTA link.

Gerilyn - Becca & Nataliebear's friend.

2/10/2006 8:44 PM  
Blogger imfunnytoo said...

A thought. Have your hospitals (and docs) office staff call the insurer and ask them the following question?

"When is our filing limit?" or give you the answer themselves, but *check w the insurance company to verify this.* Many hospitals and docs that have relationships with insurance companies have contracts that state that they must bill the insurance company within 30, 45,60,90 180 or 365 days of the date of service. If your hospital/physicians have those types of limits, see if any of them are the 365 day variety.

Also find out the companies that do the xrays or imaging, the lab work companies, the ekg or eeg companies and ask them *all* to submit the bills as late in their timely filing period as possible. (until you hit September 2006.) *Then* they should speed it up so you wont have the costs showing up again in Jan 2007.

It will give you more time to find other options.

Also, check with your insurance company and ask them "If my daughter's doctor or hospital (or assistant surgeon, anesthesiologist or other medical provider) does not have any contracts with you, how long do they have to file before you reject the claims as too old, not just as being over my yearly max?"

(keeping that September 2006 date in mind. )

Does only one of you have insurance? If it is both of you is she on both of your policies? If not can she be added to the one she's not on? If it is only one of you can the other get insured?

and maybe the thing to do is take the 3k a month policy and fundraise for the premium costs of that...and your out of pocket share of that coverage. The costs will be less than the vast out of pocket of not choosing that insurance.

And last but not least, does your insurer offer a right of appeal? If it does I would pursue that also and check with the hospitals senior billing staff as someone else has suggested. Good Luck

2/11/2006 8:26 PM  
Blogger Diana said...

I was thinking of you and Annika the other day and for the life of me could not find the link to your site anywhere.
And today it's in my face, because of course Karma likes to kick us all in the ass once in a while.
Every time I read something of yours I cry. Happy tears when she's doing great, sad tears when she's not. I hate the cosmos for making you guys go through this. I'm sosososososososososo sorry.
I wish I could do something to help. If I had money I would send you some. But I'm at the point that I don't know how we're going to eat dinner for the rest of the week...
If there is anything else ANYTHING else at all I can do, let me know. I want to help.
Hugs for you and your family.
Really, if there is anything...
If she needs something sent to her and I have it I will send it.

2/14/2006 2:33 PM  

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