November
2009
I Can Haz Healthcare Reform plz?1
So as mentioned a couple of months ago, our primary insurance changed at the beginning of September.
Fairly shortly after that, I got (several) letters in the mail from our new insurer MVP. These stated that Dorrie’s ventilator, oxygen and respiratory supplies had been authorized for one year. Presumably next year they will decide again if she’s allowed to keep breathing.
I never got any letters stating her enteral feeding supplies had been approved, but though this made me uneasy, we had updated our feeding supply company about the change in insurance, so when September and October passed without any incident, I put those feelings aside. As it turns out, this was not correct. At the beginning of the month, after two months of supplies had been delivered and were supposed to be billed to MVP, we got a call from our supplier telling us they’d just discovered that they were considered out of network and MVP would not pay them for the supplies.
AUGH.
Two months worth of formula (32 cans at $37/can), bags (60), feeding tube extensions (8), replacement G-tube button ($160), assorted syringes, feeding pump rental are easily $1500 and possibly more. We’re still at this point not sure if we’re going to have to cover these costs.
In any case, we called MVP and asked for the name of an in-network company we could use instead. They provided one, and we called them up. We gave them our list of supplies and after a couple days they came back with a reply: MVP would pay for the feeding pump rental and (presumably?) the g-tube button replacements, but they would not pay for the formula or the other ‘disposable’ supplies.
Clearly this was not acceptable! Fortunately, NH law states that the formula must be covered if we have a doctor’s order, something MVP was apparently aware of, since when we called them they didn’t seem to argue about it (though they also have yet to actually pay for any, so we’ll see). But they are still balking at paying for the other supplies. Why the hell would they pay for a feeding pump and g-tube if they won’t pay for the supplies that allow us to use it? Even the doctors are boggled, because these are all things we have an order for and they are clearly a medical necessity, necessary to sustain life. You may die slower than if you didn’t have oxygen but you still need food to live!
Anyhow, we sicced the doctor’s office on the insurance about the supplies, but we also called NH Medicaid, where Dorrie has secondary insurance due to her medical disabilities. They said that they will cover the disposable supplies if we cannot talk sense into MVP. So we called the new company back and told them to get going. Except. They then informed us that they do not work with medicaid for enteral feeding supplies.
AUGH.
So we called MVP back again and asked for another feeding supply company. We confirmed with this company that they do, in fact, work with both MVP and Medicaid. Of course, all of this song and dance took a whole extra week and we just asked the doctor to fax all the orders to the new company on Friday afternoon, something that will not actually occur until Monday. In the meantime, the original supply company needed their pump back, and UPS picked that up from us yesterday. Hopefully we will get our new pump from the new company before the end of next week. The old company has not yet collected their IV pole, but I am sure they will need to do that soon, and we are still arguing with our respiratory supply company about having them send us one (since mostly we need the pole for the vent and humidifier).
And then, on top of this.
After multiple faxes and phone calls, we managed, in September, to get Dorrie’s PPI Zegerid approved by MVP. Now, Medicaid has placed it on the list of drugs it will not cover, so if we want to continue using it, we’ll need to pay the co-pay. The end of the world? No, but still another pin-prick in a week full of stab wounds.
Dorrie was miraculously approved for Synagis for a third year (and yet they will not pay for feeding bags?). MVP contracts with a mail-order pharmacy to send this out, but they also told Dr Optimist’s office that they could just add Dorrie’s dose in to their general order and get it all at once from their usual supplier. This broke the brain of the mail-order pharmacy and they called us and the doctor’s office half a dozen times, utterly confused, trying to find out when and to whom they were supposed to send it.
So, in short: MVP, a company I had never heard of prior to September, now has commercials on tv every five seconds telling us how awesome they are. This is a BLATANT LIE. They have been nothing but a headache and their current refusal to cover medically necessary items may be ‘legal’, but is definitely unethical.
Health insurance in the US only works when you need to use it only rarely. If only one CEO of one health insurance company had a catastrophic illness in his or her family, then they might start to act ethically.
(November 29th, 2009 at 1:19 AM)