July 27, 2007

Insurance is a Wonderful Thing!

Having insurance is a wonderful thing, just ask anyone who doesn't have it. We are fortunate to have excellent coverage and feel blessed for that. In the process of learning about Evan's condition & choosing his best options for treatment, we have traveled to multiple states for additional opinions and tests. All the doctors have been in network and we weren't even required to get referrals. Having insurance is a very good thing.

But there is also a downside to dealing with insurance companies and it seems to be the way the overall industry works...they deny a LOT of claims and send bills for things that have already been paid. Trying to resolve these matters requires hours of time on the phone while being transferred from person to person. It is frustrating and exhausting. After all this effort the bills are usually marked as paid because they are for covered procedures, but it is a continuous hassle.

Our most recent issue is with getting a MEG scan for Evan. This test has been identified as necessary to determine exactly where Evan's motor strip and sensory strip are located. The tuber they want to remove is on or near one of them, but there is some question as to exactly where the cortex is located in Evan's case. Basically, the tuber, motor strip and sensory strip all formed at the same time in utero and the formation of the tuber may have caused the two strips to move over a little. The MEG scan will identify where all the brain cortx is located and will then be overlayed on the MRI to give a clear map of the tuber and the cortex involved.

NYU hospital requested pre-approval for a MEG scan from the insurance company. They denied it. NYU sent in an appeal based on medical necessity. They denied the appeal. We can appeal it one more time before we are stuck with the bill, so we are preparing to do that. We're working with NYU Hospital, the insurance company and the HR representative who manages the account and hopefully everything will work out in our favor.

I am optimistic the insurance company will see things our way and realize how important this test is to the success of brain surgery for Evan. Having insurance is a wonderful thing and we are so grateful to have it. Now they just need to compromise and do it MY way!

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