Wednesday, September 16, 2009

Sticker Shock

This month we didn't get approval for insurance to cover Daniel's special formula.

See Daniel only gets his nutrients from a special formula that has everything needed in it to keep him going. He needs to drink 5 of these 8 oz. bottles a day to get what a child his size needs.
Well it have always been covered by insurance but now, if the child is orally fed, they won't cover it. If he has surgery and becomes tube fed, then they will.

WTF right? why put my kid through surgery (painful from what I hear)
It is all so stupid. Get surgery and we'll cover it. If I would I'd feed him normal food but he can't. Because of his condition he has paralysis of his facial and throat muscles. We struggle feeding him anything and it would take him all day to eat. But the boy can suck down a bottle like no other (when he wants).

So, we can get it from the company we have been for a mere $128.00 per case of 27 8 oz. containers. 5 containers needed per day that would be a little shy of 6 cases per month. Care to do the math on that one? Here I'll do it for you cause its etched in my head

$768.00

Anyone got that extra money per month? Jesus, makes me sick.
I hate people who put something into effect and don't think about the people they are affecting.

8 comments:

blogzilly said...

That's unreal. And unfair.

Insurance companies BAFFLE me.

I assume you have someone over there you can get in contact with higher up? Might be time to unleash the hounds on 'em.

Laura said...

Oh I really hate insurance companies and their "rules"! If Daniel is taking nutren jr I do have about 6 cases he is never going to use and you surely can have it at no cost!! How is school going for him?

Sherry C said...

wow I've never been so thankful for being Canadian. That is just so unfair. Do you keep a lawyer on speed dial to help you fight these on going battles. Like you don't have enough on your plate.

Amy Genn said...

Our insurance gets billed over $2500 a month for our son's feeding supplies and formula. (He is tube fed, 100%)

It's a racket I tell ya!

Katy said...

Seriously makes me want to VOMIT! It's like a conspiracy to get a feeding tube in every kid with special needs.

We had a similar situation with thickener for Charlie. They called it an "additive." It was an additive that prevented him from having pneumonia but still. . . not covered by insurace--like i was asking them to pay for nutrisweet or something!

kate said...

Wow. I hate insurance. Does Daniel happen to take Boost for kids 1.5? (used to be called Resource) We have extra & some are set to expire by the end on November. We were going to give to our dietician for samples but I would love to send your way if you can use.
Kate

Memphis said...

Check on getting WIC. That is how we got Memphis's formula paid for. Becky the ntritionsit at Dr. C's office told us we could get WIC, even though we make to much money. CSHC would not pay for Memphis's formula but any child who is on Medicaid including CSHC is WIC eligible. Email me if you have questions curellmi@hotmail.com

C said...

Is this something that would be covered by Title 19 funds? Or help Daniel get Title 19 coverage? Can I come with you to find your reps and complain? Perhaps with a camera crew in tow???

Q is on the Boost 1.5/1ml, in addition to solid food and I cannot imagine trying to cover this myself. We would be living on the street. Thank God our SLP was given dozens of cans of Thicken Up -- not cheap.

(((((Mel and co.)))))