About Health Insurance - the approval.....

I realized I forgot to mention in my first post, our health insurance did finally approve Brian's surgery a few weeks ago.  Doug and I could not have afforded this surgery if we had to pay for it out of our pockets. 

Brian's first surgeon required cash upfront.  I initially thought Doug and I could apply for medical loans to cover it - but it turned out these loans are not easily obtained in this economy.  We wasted an entire year with our first surgeon because I believed I could figure something out. 

I finally admitted to myself that I could not afford this surgery on December 24, 2010.  That day my Dad drove Brian and I to Phoenix Children's Hospital.  I did not know anyone there; I was simply looking for options.  To my amazement, the staff there took the time to talk to us about Brian's situation.  The admissions office provided me a list of surgeons I could contact.  That is how I found Brian's current surgeon, but there were still obstacles to overcome.

1. The surgeon rarely accepted jaw patients because of the difficulty with working with insurance companies.  However, once she examined Brian, she agreed to take him on as a patient. 
2. Orthodontic re-work was required because the new surgeon's surgical plan was so different than the first surgeon's surgical plan.  Brian would have to return to orthodontic care for nearly a year.

It took 5 months from the time Brian was orthodontically approved for his jaw surgery to be approved by the insurance.  The insurance denied several pre-authorizations and claimed required paperwork was never received.  The insurance also tried to state that there was an exclusion on our policy; however, no one could ever show me the exclusion, in writing, anywhere on our policy. 

Verbally, the insurance told me that Brian could only have the surgery if he had one of the following:  Cancer, Traumatic Injury or Sleep Apnea.  Although Brian had not been screened for sleep apnea, I knew his facial structure was made for this condition.  Sleep apnea is when a patient stops breathing multiple times for several seconds during sleep.  Brian's deviated septum, enlarged tongue and his jaws made him a good candidate for sleep apnea.

We had Brian tested, and he was found to have mild sleep apnea, which does not usually require surgical intervention.  I was hopeful because he does have sleep apnea, but cautious because I knew this might not be enough for the insurance.

After weeks of the surgeon's office going back and forth with the insurance, the insurance finally arranged a phone conference between our surgeon and a surgeon/doctor from the insurance company.  The conversation lasted about 20 minutes, and at the end of the conversation - Brian was approved by the insurance to receive his jaw surgery.

The moral of the story to families out there going through this is - don't give up.  Keep trying - get the tests done that the insurance needs - read the medical policy for your insurance - ask questions - and most of all, find a surgeon who will work with your family situation.

I apologize this was such a long post - but I wanted to get it out there for other Mom's looking for answers.

For now, Brian is looking forward to the surgery, but it seems more real to him everyday.  He and I talk about what foods we can put into the blender.  =)