Monday, September 21, 2009

A Day of Bad News

This morning, my HMO (Blue Cross Anthem) called and said they were denying Benjamin's medical coverage at Johns Hopkins! I was pretty devastated, but called and cancelled our appointments and travel arrangements.

I asked about our other options, and Josh spoke to our surgeon here in Springfield. He referred us to Dr. Park at St. Louis Children's and we made our appointment there. I cancelled my substitutes for next week and prepared for us to go to St. Louis.

By lunch, Blue Cross called again and denied our coverage there too! So we asked, where in the United States could we go that would be covered by my HMO. They said we can only go to Cox South in Springfield, where we had the first surgery. I emphasized why we need a second opinion in our case, and even our surgeon is in favor of a second opinion.

We were granted "special" permission to go to Cleveland Clinic Neurological Institute to get a second opinion and have our HMO coverage. I asked for this statement in writing before I go through everything to arrange a visit and travel accommodations. They said they would fax it to my pediatrician along with the referral paperwork he needed to fill out.

After school today, I stopped by the pediatrician's office and they hadn't received anything. My pediatrician doesn't even know why they would want to talk to him, because he can't really give his assessment on our situation from a neurosurgery perspective, and they should really be talking to our neurosurgeon instead. Either way, the pediatrician offered to call in the morning, try to help us get an appointment, and explain our situation as best he could, but they will most likely want to talk to our surgeon as well.

That's all fine with me. I just want this to be over with! I called the insurance company back and said they would re-fax the letter to the pediatrician's office as well as to my work tomorrow morning. After that, and after we have an appointment, then I will start with the travel arrangements.

My husband called Cleveland this afternoon to talk about what was going on, and they were very hesitant to schedule a consultation, pre-op and surgery date in one visit, so we will most likely be traveling there two to three times over the next couple of months.

I just don't know what to think now. My pediatrician said that if we don't have a letter stating Anthem Blue Cross will cover the Cleveland Clinic Neurological Institute by tomorrow at 5:00, then we should probably get a lawyer.

I feel like I'm on such a roller coaster right now. We've gone from leaving for Baltimore on Saturday and having a surgery date in two weeks, to having no idea if and when Ben will even have a surgery.

I know that everyone I know has heard me repeat this numerous times over the past week, but we are the reason health care needs to be reformed. No matter your opinion of President Obama, something needs to change with our system. An infant shouldn't be denied the best possible care, especially when it is involving brain surgery. This is all so terribly unfair, and could be easily prevented with the right legislation.

This is such a big blow. It is making it really hard to be a good mom, wife, teacher with all of this rattling around in my head. I hope I have really positive news to post soon, and know a little more about what's going on.


  1. Lara, this is unbelievably unfair and I'm so disgusted with Blue Cross right now. I know we are far away, but if there is anything at all we can do to help, please call.

    Jenn Albin

  2. Our issue was nothing like yours, but I had to enlist the help of Missouri Dept of Insurance regarding Anthem BC/BS this year. I got nowhere with Anthem on my own. For one thing, BC/BS wouldn't even send me a copy of our insurance certificate so we had no idea what our coverage even was (their supposed 'web link' for the certificate was non-existent). I found the Dept of Ins to be extremely helpful. BC/BS was NOT. So if you continue to get the runaround, talk to DOI. They were so helpful! Best of wishes to all of you. -Tammy

  3. Lara-
    My mom retired from the MO Dept of Insurance, where she worked for the Director for several years. You should give them a call. This is what they are there for. I'm sorry you're having so much trouble. I'm sure, though, that you'll get it all straightened out. You are Ben's best advocate - no matter what health care system is in place. And, I also have had a great friend travel to Cleveland Clinic and she says it is a WONDERFUL facility! I know everyone's experience is different, but she has traveled there several times from West Plains and says that she would do it again in a heartbeat. Let me know if you need help getting in touch with the Insurance Department. I can call my mom and get names and numbers for you, if you need them.

  4. Beating my own noggin against something for you. I agree, it completely sucks that you can't get coverage for a needed operation. Argh.