Sunday, February 2, 2014

Tearing our hair out!!!

Seriously!! Michelle and I are going to be bald like the babies before long! Michelle's experiencing record setting hair loss thanks to the drop in hormones. She can't shower without pulling out a handful of hair and got out of the shower last week and asked "will you still love me if I'm bald?"  Of course, the answer to that question is yes, but I'm trying to convince her that this happens to everyone and she is not going bald. =)

And I think we both might be bald from tearing our hair out after dealing with insurance for the past couple of weeks to get the last Synagis vaccine paid for!  If there's one thing triplet moms don't have in abundance, it's time and it is maddening to spend an hour on the phone, half of it on hold, only to hang up without having made any progress whatsoever!  The whole reason we applied for Medicaid was because our pediatrician warned us that the copay for Synagis was ridiculously high.  But now that we have it, the two insurance systems seem to have no idea how to play nice.  And what I can't understand is why no one seems to be able to provide any guidance on how we navigate these two systems.  Surely we are not the only family dealing with this situation!!

To make a long and maddening story short, the primary insurance Aetna, only pays 50% of the cost which leaves us with over a $1000 copay PER KIDDO for ONE SHOT!  The kiddos are enrolled in one of the PA Medicaid HMO plans called Geisinger Health Plan, but the Aetna Specialty Pharmacy says they can't bill the GHP plan so they referred us to another copay assistance program instead. (Getting this info took four phone calls for a total of over two hours!)  Only problem, that copay assistance program can't help you if you are enrolled in any Medicaid plan! (whoops! there goes another 30 minutes!) The GHP folks said that Aetna Specialty legally has to bill them and can't "balance bill" us because the kiddos are in a Medicaid plan. But that regardless, the pediatrician needs to submit to GHP for authorization before they will pay anything and they don't know until that auth is approved how much of the $1000 they will pay. (The rep was very nice, but had to talk to his supervisor so there went another hour!)  Next the pediatrician's office to make sure they submitted to GHP for authorization. "Oh yes, of course we did, but let me check the system to make sure.  Oh, no, I guess we don't have auth from GHP yet.  Let me just resubmit everything on Monday."  (20 minutes gone!)

OMG!!! So, clearly, the kiddos will not be getting their third Synagis shot on Tuesday at their 4 month well check up.  And who knows if they'll ever get it.  The nurse at the doctor's office said "Well, at least they've gotten two doses!"  As if that is supposed to make me feel better?!  Their primary insurance, who doesn't want to pay for any of this, approved them for three doses so I feel like they should be getting all three doses.  If one of our kiddos gets RSV because of this whole insurance shenanigan I'm going to lose it.  And really, if one gets it, they'll probably all get it, in which case, you might have to check me into a sanitarium for a week! (do those even still exist anywhere?!  I guess a spa retreat would probably work too!)  ;)  

1 comment:

  1. The games seem so intentional, too. I called mine, because nothing was being paid...they said 'oh, we needed to know if you had any other coverage.' Waiting for another company to pick up before they did! Nope only one coverage here, pay away, UMR!


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