The next couple of months were like a lesson in insurance 101. Really, they should have someone come explain to you how all this works when you're in the hospital with your child. I mean, they have the chaplain come, the social worker come, the lady from hospice come...why not an insurance counselor? Anyway, I had to learn really quickly what an EOB (explanation of benefits) and what they mean (nothing). But I think the hardest thing for me was figuring out who was Sadie's primary insurance and who was secondary...apparently since Brian's birthday comes first in the year (even though I was born before him), he's primary. So confusing. Luckily, my mom worked in insurance for a lot of years, so she was a good resource!
But I got a lot of it figured out. I've learned what questions to ask, what to argue about, and what to just not pay.
Now Sadie has something called Long Term Care. This is basically a branch of our state assisted insurance program that covers everything our private insurance doesn't because they recognize that Sadie's condition is long term and that $30 copays add up over time and that she's going to need extra equipment! The greatest thing about Long Term Care though is that I no longer have to worry. I never get a bill, and if I do, I know I just need to make a phone call and I won't have to pay for it. Long Term Care pays for Sadie's feeding materials (ie. formula, tubes, buttons, syringes, bags for the pump, thickener, etc) and they send someone to our house with a delivery each month!! They paid for our chillout chair. And they provide the respite care we get.
Finally, Sadie was enrolled in something called Child Rehab Services (CRS). I really don't understand CRS. On one hand it seems like a net to catch families who don't know how to navigate the system or properly care for their child. But on the other hand it seems like another branch of state provided insurance/services that Sadie gets for free. We visited the wheelchair clinic through CRS, and even though the wheelchair (which is around $3000) has to be submitted to our private insurance for approval (and even then they'll only pay 80% probably), they didn't wait to order it because no matter what our private insurance will or will not pay, CRS will cover the rest. We WILL get a wheelchair and we WILL get it for free. So nice.
So, today I am thankful for insurance and that we have such amazing benefits both privately and through the state. I don't know what we'd do without it... anything relating to special needs always costs 3 times more than it needs to!!
Now if we could only find a way to speed up the process!!