Hi Friends,
Insurance did not pass Evie's surgery over the phone. It's okay. It was a long shot, but it was worth spending some time with God asking him to answer our prayers, and thanking Him that he truly can do anything.
UNMC HR is meeting next Tuesday the 15th, to decide if Evie can go "out of network" and have her surgery done at Children's. Big prayer request. That gives us 8 days to pray. Join me on my knees friends, I need you!
Lastly, I feel like I'm stuck between a rock and a hard place. I'll be honest, when we left the neurosurgeons office at the end of May, and scheduled our Cranio-Facial Clinic visit, I totally got the impression that Evie would be having surgery this week. Now we are just starting the approval process with insurance, to prove that her surgery is "medically necessary"... and begging UNMC to let us go out of network. It's sounding like 4-6 weeks. It blows my mind that a nationally known neurosurgeon can examine Evie, look over her scans, say that she absolutely needs surgery... yet we need a "medical review board" (whatever that is) who has never examined her and hasn't seen her scans to deem it medically necessary. I just want to send them a video of her sweet face and ask them to please take care of my baby.
I feel like I am trying to decide whether I should:
(a) assume that these setbacks are all part of God's plan for Evie, and that as her mom I need to be patient because all things will get passed at a time that is good for Eve... or
(b) be more demanding and advocate as her mom that my daughter NEEDS surgery... NOW... and pool my resources to get things moving. But I don't want to take things out of God's hands, he knows when and how surgery will go.
I feel like right now I have found a happy medium between the two by calling insurance every other day to see how things are going... giving them any pertinent information, and requesting that they call me with updates, but sometimes it just doesn't feel like enough. Will you pray for me that I can know with certainty exactly what to do? I am so so so afraid that Evie will take a turn for the worst, and this surgery will become an emergency situation... which isn't good for anyone involved. Even YOU insurance! (:
Thanks friends, I appreciate you!
Love from the Elsaessers.
Be the demanding mom. Insurance companies are horrible to deal with. You need to keep putting pressure on them.
ReplyDeleteMy prayers are with you and your family.
Insurance companies aren't the enemy, they have their protocols that they have to follow just like any other business. That doesn't mean you shouldn't stay on them for a decision, just don't feel like they are out to get you. :-)
ReplyDeleteThe "medical review board" is typically the medical director at the insurance company reviewing the records to determine if the procedure is medically necessary. Don't be afraid to request a peer to peer review - this would mean that Evie's neurosurgeon would speak directly to the insurance company medical director to make a case for medical necessity. This also stops a lot of the back and forth and waiting to get records, etc.
Hope this helps. Good luck!
I agree with the first poster. Be a demanding mom. And that's all you can do. Can the surgeon write a letter or make a phone to let them know the urgency of the surgery?
ReplyDeleteMany prayers to you and your family.
klj
Definitely be her advocate. Insurance can be difficult. In my experience with insurance, I just keep going up the ladder until I can get someone to answer my questions or until I get somewhere. Even if you are more demanding and get somewhere or get nowhere...I think its still in God's time and his plan for her.
ReplyDelete