Wednesday, November 14, 2007

Hoops

First of all thanks for all the well wishes and support. I was reading my last post and it looked a bit like I was implying that the syrinx was back, I didn't mean that at all. The syrinx, when last checked, was great. Gone almost. It is the scoliosis curve that has gotten worse.

So, I have spent the better part of my day jumping through insurance hoops. Gotta love health insurance. It turns out that out of network can suck big time. We are covered out of network 80%, up to $2500 yearly, and a $1000 deductible. Garbly goo, eh. In layman terms it means bend over. The brace itself costs $3300 (ouch I know) and after the assorted math we'd be paying roughly $1800 for Simon's new brace!

So began my phone calls. Is someone in network that can do this? Yes, only one though and then it's 100% covered after the $500 deductible. Great, but not at all that easy. You see the doctor he goes to is in East Brunswick and yes, he is out of network but there are no pediatric orthopedic docs in network for us so we go to him. The people he uses/refered us to for the brace are in the same building and they have a long standing, 25 year, relationship with them so they know what to expect. Obviously I have the right to use whomever I want. So, to use these other people I'd have to get the prescription and xrays from the people we went to yesterday, do all the getting approval through insurance, new appointment for Simon to checked and fit again, and did I mention that they are in Hazlet. East Brunswick is about a half hour away in good traffic one way and Hazlet is about the same distance in a different direction....AHHHH!

After talking it through with Dan, even though the price difference is significant ($500 vs. $1800), we've decided to stick with who our doctor recommended. I don't want to take 10 steps backwards, get Simon fit for a brace again, or drive all over hell and back to save money. I feel most fortunate that we can say that. Our decisions for our children don't have to be based on what can we afford all the time. Although, at holiday time this much money could be used for lots of other things. I am sure Simon would get a good brace from the other people but I don't feel like it's right. I want to stay with what we know and move forward.

Why can't insurance companies just make life easy? We didn't have any issues with the surgery at all... oh wait, that was in network.

5 comments:

Amy Y said...

Here, here!
Careful who you vote for next year... Perhaps there is hope on the horizon where health insurance is concerned?

What a pain in the ass... luckily you are fortunate in being able to choose who you want to take Simon to. Glad he won't have to go through all that drama again!

Samantha said...

Oh, I am so sorry to hear about this. Poor Simon! Poor you guys. Sending warm fuzzy thoughts your way...

woman at the well said...

Now you know how people end up broke, even when they have medical insurance. Goodness - congrats on hanging in there and figuring all this out. Wish you didn't have to ...

Ria said...

OMG ELLEN! I just got all caught up on this. I am so sorry to hear this is going on. Poor Simon! I wish you were here so I could give you a big hug. I will be thinking about all of you. Then to have to deal with insurance companies on top of it all...UGH! Sending you happy thoughts and well wishes.

Susan said...

Sorry that you have to pay more out of network.

BUT, remember the bright side, you have doctors you trust & are comfortable working with. And that is worth the extra money,any day.