Insurance BS Continued

We’re a few weeks into physical therapy now. It’s frustrating. DS2 is shy and takes a bit to warm up to new people. We’ve seen a different therapist at each visit. By the time he warms up to them, he gets in maybe 15 minutes of actual therapy. I’ve repeatedly asked for a consistent therapist, which his orthotist and orthopedic doctors recommended, and yet each time we show up, it’s someone different.

“There’s only so much we can do with the scheduling.”

Super helpful. I love driving over an hour one way, for an hour long visit, to get 10-15 minutes of therapy. I have not had to pay a co-pay, despite asking at every visit. They just tell me it will be billed and I’ll be contacted. Nearly a month in with no bills, I’m worried.  Mentally preparing myself for the sticker shock when I open the envelope lol.  Haha!  Speak of the devil, a bill arrived today:  $400.82 for evaluation.  No session bills yet!

I bit the bullet and applied for secondary insurance. It was approved for DS2, and we were told this would cover co-pays and whatever percentage our primary healthcare insurance did not cover. I do have a $30/mo premium for this secondary insurance, but I thought this would be a bargain based on the expenses we’ve faced with his needs.

Showed up to PT yesterday and they informed me that the secondary insurance, let’s call it KidsCare, will not cover PT. Apparently KidsCare no longer covers outpatient rehab therapies. This includes speech, physical, and occupational therapy.

So what is the point? I find myself asking this question repeatedly regarding insurance.

Two weeks ago DS2 received his newly fitted orthotic braces. These are $5,200 for the pair – they are plastic and velcro – and fit in the palm of my hand. Here’s an example pic:

smo_product

Just imagine them much smaller. My son’s foot is a tiny and fat, size 1 (up from a 00)! But has to wear a size 4XW to accommodate the braces, which he needs to walk and balance properly.

Anyway, orthotics processed our primary insurance and KidsCare at the appointment, and informed us that KidsCare probably won’t cover anything. Orthotics falls into the “cosmetic” category.  COSMETIC!!??

This morning I received a letter from KidsCare approving the braces!! However, the letter clearly states that they are only approved between 07/20/2017 and 08/20/2017, and that they must be purchased through a specific hospital. What?!  When I applied it stated KidsCare covers anyplace that accepts KidsCare.

Our appointment was the 19th. We’ve been seeing the same specialists since he was an infant. Hell, since prenatal stages! I’ve tried calling the number, but they are always “experiencing high call volume, please try back later”.

If KidsCare does not cover these braces, our portion after primary insurance, will be $2,945.50. For plastic and velcro.  

No wonder medical bankruptcy is rampant in our country. The mark ups are outrageous!

IMG_8881

My son: birth, casting, bracing stages.

Another example, DS2 must wear specialized boots and a connecting bar to bed every night. Through our orthopedic office, these are $2,890.00. Insurance only covers one pair every two years, and even then only 60% coverage after deductible is met. KidsCare does not cover these at all. Apparently insurance expects kids feet to just not grow for two full years. On average we replace boots every nine months. So, $2,980.00 for boots, an additional $350 for the bar. Yet I can go directly to the manufacture and buy the boots AND bar for $300 shipped overnight. Now tell me, what would YOU choose? I understand a mark up, but $300 to over $3,000 is ridiculous.

I guess right now I’ll just wait and see what KidsCare covers to see if the $30 per month is even worth it.  I mean, if they’re not covering a majority of his visits and specialists, I might as well save that $30, right?

Medical and insurance stress are getting the best of me lately!  I appreciate all of the comments on my recent posts.  Thank you so much for your suggestions, advice, and kind thoughts.  Sometimes those make my day after dealing with all this!  🙂

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2 Responses to Insurance BS Continued

  1. Sue says:

    I am so sorry you have to keep dealing with this insurance BS!!! Just keep being your child’s advocate – no one cares about them as much as we do – sometimes it is hard to continuously deal with the crap, but I have a feeling you will do whatever you have to for your children!!! GOOD FOR YOU!!!

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  2. Heather says:

    I’m sorry you are having to deal with all this. That is stressful. I think everyone should have catastrophic only insurance, and pay for everything else out of pocket. But catastrophic only plans aren’t really available. The costs of medical services is ridiculously high. But it’s not only the insurance companies, it’s also the physicians who have contracts with the insurance companies. They negotiate their prices they want to be paid in order to participate in that companies network. So in essence, because they can get more money from the insurance company, they inflate their prices. Self paying patients are charged closer to what the prices should be.

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