Re: I finally got the insurance company to pay for the NEOCATE

[Guest guest]

Hey Sharon,

Hi!!! I spoke with my husband and we found tickets from Pitt ro Phily for

$72 bucks. Are we still on??? Are you sure Clayton will be okay?

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> From: SDidinsky@...

> To: eosinophilic gastroenteritis (AT) onelist (DOT) com; refluxmoms (AT) onelist (DOT) com;

okbabes (AT) onelist (DOT) com; guardian@...; mito@...;

gtube@...; our-kids@...

> Subject: [eosinophilic gastroenteritis] I finally got the insurance company to pay

for the NEOCATE

> Date: Thursday, August 06, 1998 11:06 PM

>

>

>

> Hi all:

>

> After 4 days of beating up the insurance company they have finally

agreed to

> pay for Clayton's Neocate formula. I spent 4 hours on the phone with the

> insurance company on Monday getting the run around. I had applied to get

the

> formula covered in December (the allegedly lost the paper work) and again

in

> March. In march they called to deny my claim, but never gave me a claim

number

> or a letter so I was unable to file a grievance. Finally on Monday I had

had

> enough and I called up and demanded to speak to the pediatric medical

> director. Of course I got 10 different people but never the medical

director.

> i finally found soumeone in techinical support who actually ;istened to

me. I

> faxed her a letter (3 pages) telling her Claytons story and the run

around

> that I had been getting from the insurance company. She also called my Gi

Dr.

> who sent her another letter of medical necessity and also

explained to

> her clayton's condition. Well the insurance company called me this

afternoon.

> THEY FINALLY GOT A CASE MANAGER FOR CLAYTON AND MEDICAL REVIEW HAS

DECIDED TO

> PAY FOR CLAYTONS NEOCATE. I WILL NOT HAVE TO LAY OUT ANYMORE MONEY. THE

> INSURANCE COMPANY (AMERIHEALTH PERSONAL CHOICE - PART OF BLUE CROSS/BLUE

> SHIELD) WILL ORDER IT AND HAVE IT DELIVERED TO ME FOR FREE!!!!!!!!!!!

>

> I feel like a great weight has been lifted from my shoulders as we were

> struggling financially to pay for the formula. The have ordered me 2

boxes to

> cover me until the g-tube and nissen surgery next friday and then they

will

> determine how much we will need. They will also be providing clayton with

a

> pump . ANY SUGGESTIONS ON A PUMP FOR A 16 MONTH OLD. We are going to try

to

> feed him solely at night - although the way he is eating by mouth may

preclude

> this (NOT EATING AT ALL).

>

> ALso we are going to try to get some type of nursing assistance to help

out at

> night when he first comes home on the tube as I am scared as to not

knowing

> what to do.

>

> I am still in shock that they are actually going to cover the formula.

>

> I also spent a lot of time on the phone with the state and we do not

qualify

> for WIC or other medical insurance at this time - mainly due to out

income.

> However, NJ does have a Catostophic Illness fund which will reimburse you

(if

> your income is less than $100,000) for up any unpaid bills that amount

to 15%

> of your income or more (i.e. $80,000 in income need $12,000 in bills).

The

> bills would include, co-pays, deductibles, mileage to the docs and

hospital,

> parking, formula, etc. Also it is for any consecutive 12 month period.

With

> all of clayton's doctors visits and hospitlizations I am sure that we

have the

> qualifying amount in bills so we are going to start to compile this info

and

> submit it.

>

> I feel like a great weight has been lifted. I guess that sometimes

> perseverance pays off - also in my letter I guess that it helped that I

wrote

> it on my legal letter head and my last sentence said that I would pursue

any

> further action that was warranted.

>

> love,

> sharon

> mommy to Jake (5)-nda, and fraternal 34.5 week twins Cole (3/30/97) -

nda

> (reformed refluxer) and Clayton(3/30/97) (eosinophil gastroenteritis,

mild

> developmental delays, food allergies (milk, soy, egg, wheat) Nissen and

g-tube

> scheduled 8/14/97)

>

>

>

>

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