Insurances shouldn't be able to do this!

[Farmwife]

My hubby gets a call that our primary insurance told they DME that our limit for the EEN (Splash) has been meant and they will no longer supply it to Grace.

I call her GI clinic in a panic and even the nurse was shocked.
I said she needs this to LIVE! The nurse said YA! She put me through to the dietitian and she said she's in talks with Grace's DME and to wait until we hear further. She think our secondary insurance will pick up the tab. It could take a week or two. We were suppose to get her supply 4 days ago.

Thank God I have a surplus of Splash that might make it a week.

I'm just mad. She needs this to live and there's a dollar amount to this????

Sorry, when Grace is in flares my nerves/patients/attitude is just shot!

 

[kimmidwife]

FW,
That is terrible!!!!! Insurance companies do really stink!!!!!

 

[Momto2girls]

I'm sorry! Insurance is the worst. Ugh! Our co-pays, premiums, everything, is also going up in 2014 -- boo!

 

[nogutsnoglory]

I would contact http://www.patientadvocate.org/ and http://www.thejenniferjaffcenter.org/ to see if they can appeal on your behalf or assist you.

 

[crohnsinct]

FW: sometimes it is simply a matter of them not having all the info and the doc just has to call and give them the correct diagnostic codes etc and it will be approved. I know it all sounds silly but there are so many different reasons for the formula and some of those reasons do have limits. Don't panic until the docs office calls the DME and the insurance company and gets a definitive denial of coverage.

Believe me...I did this for a living full time...called docs offices and insurance companies and crossed all the t's and dotted all the i's...it is cumbersome but there is no other way.

Hang in there.

 

[Farmwife]

Believe me...I did this for a living full time...called docs offices and insurance companies and crossed all the t's and dotted all the i's...it is cumbersome but there is no other way.

Hang in there.

Well I'll be I thought you got you attitude from the city.:ylol2:

I was told that they tried with the Insurance but they said they're not cover it.
Our BLESSING is that we have spec. children's insurance through the state. Thank GOD!
My heart breaks for those that don't.:confused2:

 

[crohnsinct]

Well hmmmm if you worked for a big self insured company the HR department sometimes calls on your behalf and requests that they cover the expense. Is your policy placed with a larger group...like cow tippers of Michigan or something? Sometimes there is a person at the group level who can put some pressure on them.

But since you have the supplemental insurance it may not be worth the aggravation....you can save that for another day.

And heck! Maybe it was my attitude that got so much covered for my employees:rof: Maybe you just have to get a little demanding and mean:tongue:

 

[Farmwife]

Well hmmmm if you worked for a big self insured company the HR department sometimes calls on your behalf and requests that they cover the expense. Is your policy placed with a larger group...like cow tippers of Michigan or something? Sometimes there is a person at the group level who can put some pressure on them.

But since you have the supplemental insurance it may not be worth the aggravation....you can save that for another day.

And heck! Maybe it was my attitude that got so much covered for my employees:rof: Maybe you just have to get a little demanding and mean:tongue:

Cow Trippers of Michgan (CTM), no we decided against them. It was run by city folk.

We went with Cow Skiing of Michigan (CSM). That Insurance company is country folk owned and their motto is........................
We're use to dodgin the bull.

 

[Jmrogers4]

Y'all crack me up. I just about spit soda all over my keyboard.
That's is pretty ridiculous farmwife since it is her sole source of nutrition I wouldn't think there would be a cap on it.

 

[my little penguin]

Hugs
I have heard of it before
Some won't cover it at all for kids with egid even though they are tube only.
Insurance doesn't care.
Hope the secondary covers it quickly .

 

[Jison0612]

Obamacare at its finest it'll only get better from here.......?

 

[Devynnsmom]

That's BS! I hope you get answers soon!!

 

[Farmwife]

Just got a call from her GI office. The dietitian hopes by today is will get covered.

 

[Devynnsmom]

GREAT news!

 

[Farmwife]

I erased the prior message.

Basically the script was up for a 6 month supply.
The time was up as far as the big mean insurance company was concern.
All that has to be done is send a new script. All's good now.:hug:

So I aged and worried for nothing.:tongue:

But hey.......the Cow Skiing of Michigan (CSM) will live on FOREVER!:rof:

 

[Jmrogers4]

Whewww! Glad it all worked out. I was ready to grab my rolling pin and storm the insurance company.

 

[Catherine]

Farmwife, great news.

Now make a diary note, for about 5 months that you need a new script.

 

[crohnsinct]

Ummmm:whistleinnocently: Love to tell you I told you so:whistleinnocently: I thought it was some technicality or something like that. Thought I was going to have to come out there and give them some city girl attitude. Glad all worked out for you. I actually might (bahahaha "might") bust open a bottle and toast to your success:wine:

 

[Jennifer]

Wow. I'm glad that's all it was Farmwife. :hug:

That's a lot to go through to find that the problem was something so simple. :yrolleyes:

 

[Momto2girls]

That's great news!

 

[Farmwife]

No go! GRRRRRRRRRR!!!!!!!!!!!!!!!!!!!!!

I was told WRONG. The lady on the phone never looked in the right files I guess.

Then I was told to get the spec. insurance to cover it that we have to partake in some government programs and since we don't, it will not be covered.
I said we don't need that assistance and she said that's what you have to do.
I said wouldn't is save our struggling state money if we didn't need or want to partake.
She said it's all so stupid and that she is sorry.

So hubby said we will get by and buy it our selves.

 

[crohnsinct]

WHAT???? I was wr wr wr wr I can't say it! APPEAL!

 

[araceli]

Yea, APPEAL. Meantime try with the company who makes the formula, some of them will give it to you at no cost. I hope this resolves quickly.

 

[Farmwife]

Honestly right now what's the point of an appeal.

It states as clear as day that's their's a max to medical foods.
Next enrollment we'll switch to a policy that doesn't cap.

On January 1st starts a new year for the insurance and I was told that it will cover the drinks well........................ until the max is meant.

Some insurances like MLP said don't even cover the drinks. So I guess I should just be happy that we made it this far.

 

[DanceMom]

I'm really sorry! Battling insurance companies is so frustrating and very rarely do we ever end up on top. I hope you get something figured out because I imagine the EEN is very expensive.