Friday, May 1, 2009

Another update it has been a week since we got back from our trip to see the Cochlear Implant surgeon. It was an extremely long day. Up early to shower and get the boys off to school so that we could be on the road by 7:45am and in Birmingham in time for our last speech appointment. We wrapped up with our speech therapist in time to just make it across town for the CT scan. They obviously have to make sure that Molly's Cochlea can house the implant and so we were really anxious to get that news back. The bad news is that they have to put her in this huge MRI machine and so they were all scheduled to sedate her. Because of the high probability of sedation, we were not allowed to feed her anything but jello and clear liquids until 9am and nothing at all after that after that. For a little girl who likes to eat constantly, I knew this was going to be painful for all of us. We got to the Radiology department and we had the best experience. The guy running the show, while I could tell he thought I was nuts, was willing to let Molly try to take the scan without sedation. She just had to lay perfectly still and I could tell that he thought we were just wasting time but was willing to give it a shot. Can you believe we put her in that machine and she did exactly what we asked her to do. She didnt move a muscle and it saved her all the time and pain of an IV and sedation. It was so great and Rob and I were really relieved. Following that appointment we had time to grab lunch ( something else we couldn't have done if they had sedated her) and drove back across town to meet with the surgeon. We walked in, filled out the new patient paperwork ( felt like I was taking the SAT) and waited to meet this man. What we were told is that we would have an hour to sit and talk to him about this procedure...what we got was completely different. He came in and sat for about 5 minutes, examined Molly's ears ( and we found out that she has another ear infection) and then he dropped this huge bombshell. He said Tricare would only approve one implant. I sat there dazed and confused. I knew I had called them ...even before Molly came to live with us and asked them the policy about bilateral implants and this was not their policy. I tried to respectfully relay this information to the man dressed in scrubs but he held to his guns. I finally said "Look, I know I have asked them this question before, and that is not their policy". He took a card out, wrote down his business managers phone number and told me to call her. In the meantime I called Tricare and confirmed their policy. No where in their policy do they state that they will only approve one implant and when I told this information to the business manager she immediately began back peddling. It was then that Rob and I figured out what was really going on. CI surgery is expensive...really expensive. Tricare insurance is not very good and if you are going to accept Tricare, you have to be willing to accept what they are willing to pay. The hospital, in an attempt to get off with as little loss of money as possible thought they would just do one implant and make it about the insurance company and not that they would potentially be losing a lot of money by doing a bilateral surgery. I can only assume that they thought Rob and I would just say"Oh, Tricare onoly approves one implant...well, okay". Anyone that knows us... okay, me anyway, knows that is not the case. We are getting two implants... if I have to wait tables at night or sell a kidney, we are getting her two implants. Yes Regis, that is my final answer. We were quickly rushed from the exam room and out of the office and told to wait about a week to ten days for the write up to be submitted to insurance. So here we are...waiting again...waiting to hear that the paperwork has been submitted so I can start harassing Tricare to get bilateral implants approved. He did agree to do both the implants at once and surgery will occur between June and August.

I will post more when I hear back about the insurance company. Thanks for all the great comments and support!

1 comment:

Tricia said...

I am so glad Molly is doing so well. She is a trooper! Sophia would have never had her MRI done without sedation. FYI: Molly qualifies for medicaid because she is a foreign orpahan that was adopted with medical needs regardless of other insurance you have for her. It covers everything your insurance doesn't. It took a few months to get the dreaded paperword done, but is has been worth it. e-mail me if you have any questions about it