Tuesday, October 8, 2019
A Win!! (Finally!)
Lately it seems like everything is a fight. Fight for coverage, fight to oxygenate. Fight to get students to focus, or at least not cause problems. Fight to figure out dinner, homework, schedules. Fight just to get moving and out of bed. No, I’m not depressed. It’s just sometimes overwhelming. Being a special needs mom is a full-time job in and of itself, and then I work full-time on top of that. Plus just all the day to day aspects of volunteering, helping other kids, and life. It’s hard!
Our most recent “fight” has involved Aaron’s eye glasses. His appointment was last April. Yeah, six months ago. But it took me a month to then get him in for measurements and I found that his coverage only allows for new glasses every two years unless there’s been a drastic change in prescriptions. His two years were up in June so why fight? Made sense. I called in June and got the ball rolling, I thought.
Called back the beginning of August, hoping they’d be ready by the time school started mid-August. Um, nothing. NOTHING! Haven’t even submitted to insurance because “they won’t cover them anyway, not the specialized ones he needs.” Really? Let’s try anyway. Call back a month later (I got busy, wedding, school starting, you know...). ”Nope, my supervisor won’t let me even ask because it’s a waste of time, they never cover them.”.
So I start making calls, trying to find a glasses distributor that is a provider for his insurance. There really isn’t one that will submit what we need without us paying for them ourselves because again, “they never cover them.” I call the doctor’s office to see if they will submit the forms since the glasses company (GC) won’t. They agree to write the letter and send it in. But when I call insurance, they won’t do anything until they get the form from the GC. I finally go all the way up the line and tell the GC that I really need them to cooperate! I don’t care if it “won’t work” they’re the only ones with the codes and prices and I need the one-page form filled out! Fine, if you really want it, we will, but we (GC, not the insurance) need all the doctor’s notes and letters before we even start.
Game on. Here’s the thing: we are asking for a lot for a typical 9 year old, but Aaron isn’t typical. He doesn’t care that glasses break, so his lenses need to be unbreakable. He can’t “take care” of his frames, so again, they need to be flexible and unbreakable. His whole issue with “breathing is optional?” Well, it’s even more interesting in the sun because he’s so light sensitive. So we need transition lenses, or he wears non-prescription glasses when outside. Not optimal.
So I figured if I was still fighting five months after our appointment, I was going to hit them with everything I had right from the start. Not only did I arrange for a letter of medical necessity from the eye doctor, I got one from his developmental pediatrician regarding his development and one from his pulmonologist about his poor lung function. I think I may have overwhelmed everyone.
But guess what? It worked! And fast!! Paperwork was submitted Ten Days Ago and I got a call yesterday!
Believe me, when I heard the message on the machine that the GC had an “update” I was discouraged. It was way too fast for good news. Frankly, initially I thought about postponing the return call. It was already almost 5 pm, but I figured I could do it then or it would get lost in the shuffle, so I did, and yeah, they were closed. This morning I had a first period prep so I tried again.
And THEY APPROVED ALMOST EVERYTHING!!!! The only thing they didn’t, and flat out won’t, approve is the scratch-resistant coating. $30. I couldn’t believe it!!
It’s still another 4-6 weeks before he’ll have his new glasses, but it’s just waiting for insurance to process the payment (since they’ve already approved it) and then the manufacturing.
We get flexible frames, poly-carbonate lenses, transition lenses, and glasses that will help him see again.
And the fight, at least this fight, has been suspended.
Which is good, because you can only fight for so long before you just give up on things, and I was almost there.
And I'm no quitter, but I'm tired of fighting.