So as all you know I had twins mid last year. Well they are in great health but the girl was mashed inside the womb. Her head has never grown quite right but it seems to be getting worse. We finally took her in to her doctor about it and she agrees things are not right. If you look down at the top of her head its in the shape of a trapazoid and her forehead is starting to bulge forward. Well this morning we were sent to a specialist and we were told we need to do something about it now or she will have future nasal problems and the back of her spine has almost no natrual protection from the skull. On top of that she will have a very misshappen head. There is a special helmet that can be custom made that will stop the growth where you don't want it to continue and lets the brain fill out the other areas to make it all right again.

The doctor contacts my insurance co and this afternoon we get a call from them. "We are sorry but your insurance will not cover the crainial repair. Do you still want to keep the appointment. The cost is $3800.00 I don't know what I am going to freaking do now. I don't have $3800.00 and I don't have the time to wait and save it up. I'm still trying to get the $22,000 worth of doc bills paid off the the insurance wouldn't pay last year.

I guess I'm just going to max out a credit card but I hate doing that too after working so hard to get myself out of CC debt.

 

Richard I am sorry to hear that Keep your head up and (to keep from getting too religious) He has a purpose for every living thing on this earth and won't put anything on you that you cannot handle. I hope and pray everything will work itself out for you and yours.

Scot and Family

 

I've had great success, [twice] by contacting the state dept. of insurance!
Both times, it would've cost me $10,000+!
Certainly can't hurt to make a call -
Hope it works out!!

 

prayer sent!

 

They read a specific clause that says cranial bands are not covered so I don't know if its going to do any good.

 

Richard,

Sorry to hear that. It's terrible that they can get away with not paying for something that should be covered. Keep us updated.

 

DON'T EVER PUT MEDICAL BILLS ON A CREDIT CARD, AND ESPECIALLY NEVER EVER USE HOME EQUITY OR SECURED CREDIT TO PAY IT!!!

The dr is obliged to take you as a patient weather or not the insurance comapny can pay. They are obliged to offer a payment plan. So worst possible case you can't make their required payments, and they send you to collections, at which point generally you can negotiate a reduced payment.

If you make an effort to make even vaugely regular payments they likely won't send you to collections. But if they do? Who cares. At least your daughters health will be getting taken care of.

I'm not advocating not paying your bills, but people abuse the system all time- so if you have good reason- then use the system in your favor.

As long as you are not using any kind of secured credit to pay it- there is nothing they can do to you, other than make you feel bad.

 

X2 Even if you send them $5 a week, if they accept it then you have a payment plan and if they deny it then they have denied payment towards a service which by default makes the remainder null and void. IIRC

 

Richard, I'm very sorry to hear what happened. No child deserves that, and it's nothing you can protect against. I also know that you and your wife will do whatever it takes for your family. I wish there was something we could do to make it better or go away. Sorry if this is the wrong thing to ask, but why wouldn't ins cover your medical bills for the birth of children? Sounds just wrong.

Guys, this whole thing is bigger than the $$$ it will cost. There's the dedication, love and support that $$ can't buy. There's also the pride that a man has to support his family. And there's the reality that Richard is between a rock and a hard spot, with both the rock and hard spot putting more pressure than ever on him. IMO he needs our support and prayers more than ever. Scott & Ben. I don't know how the US handles this, but I hope what you suggested is in reality a workable solution.

When I hear about stuff like this, I'm sorry but I really wonder if there is a loving and just God and what purpose this serves? (this is only a personal reflection of sorrow and grief - not intended to start a religious diatribe)

 

Richard,

Try and fight it. If you can prove it is medically necessary and will prevent future medical problems alot of time they will cover it. It will take alot time and phone calls by you,your wife and your doctor.
I went through it with my daughter, she had a small palette. When she was 10, the doctor wanted to put a expander in her mouth and let her mouth naturally expand. The insurance said no but they would cover putting her in the hospital, splitting the roof of her mouth open, then fixing the problem when she was 16. I still can't figure that out. It took about 3 months of beeting are heads against the wall but got it covered.

Larry
My prayers go out to you and your daughter

 

They did cover it 22k was my portion. Since the girl had to stay in nic-u for a week the bills added up quick.

 

Wow! I had no idea how expensive health care is down there. Sounds worse than saving for college.

 

Wow, this sucks. I completely agree, the insurance companies and the hospitals are out of hand. Healthcare costs are astronomical, and yet everywhere you turn, there's another insurance company or hospital advertisement.

Anyway, it sounds like there are options, hopefully you can find a way to swing it without going into too much debt -- which is what insurance is supposed to be for in the first place...

 

Richard, I feel for ya... Insurance can really suck. Why cant they pay for something that is a medical neccessity? Are they thinking it is just for "cosmetic improvement"?
Anyway, lots of good advice has been given above. Try to work something out with the doctors. Maybe they can reduce the cost. They have negotiated rated for ins companies - why can't they give that discount to you? Geez.
If no luck there, how about a different doctor?

My ladyfriend has no insurance and had to go to the hospital for pneumonia. She let them bill her then she just worked out a payment plan of like 20 a month or something.
Everytime I balk at the dentist about the high cost of repairing my ratty teeth, they immediately say I can work out a payment plan.
So work out the best deal withthe doc, let them bill you and work out a payment plan. Should work - its not like you are running away from it.

My prayers are with you and your daughter - I hope this gets taken care of in the best way for both of you.
Heck, for that kind of dough I figured you'd be out in the shop making her a custom helmet from scrap metal..............

 

Keeping hounding the insurer. I think their first line of defense is to just say "no" and hope you go away. Like the old TV ads with David Spade. http://www.youtube.com/watch?v=Mv3M-XotQkQ

In all seriousness, good luck to you and your child regardless of how the insurance issues work out.

 

gotta do what ya gotta do , I would in a heart beat , you can always pay the card back ..... BTW im in debt over my eyeballs too .... sorry to hear of your bad luck

 

Sorry to hear this Richard, I know you guys have been through alot in the past few years. I would talk with the doctor and explain your situation! See if they will work something out.

Maybe we can get a fundraiser going thru some of the local car clubs to help out!!!!!!!!

 

agreed fight it, fight it, fight it, and don't pay with a credit card, you can pay off medical bills little by little as mentioned. That's all my wife does is call the insurance company and fight with them, it stinks and part of the problem is so many scumbags fake injuries etc that those in real need get shafted. So much of our income goes towards month premiums only to have very little covered. I spend most of my year working to cover health expenses.

 

At the risk of exposing the "elephant in the room", these Insurance companies need to be reined in...there's got to be a better way.

 

Sorry to hear this, Richard. Like someone suggested, I'd go talk to the county or state about some assistance. There are programs to help in these kind of situations, for people who need them! It's not like you're trying to shirk your responsibility or anything for heaven's sake! As everyone is saying, fight it. I know calling and calling places is a pita, but it may work to your advantage! There has to be an agency somewhere that can help, or the hospital themselves. A lot of hospitals have a social worker who helps in these kinds of situations. I'd go talk to them! Try not to use the credit card... all the interest you'll be paying back.... been there, done that Good luck to you all!

 

Richard, I'm an insurance broker in Michigan and I specialize in group medical benefits. If this is an employer sponsored plan get them involved as well as the broker who handles the account. We get paid to help with the plan and claims issues. Especially something like this. The employer wants an employee concentrating on their job and being productive. Not worried about medical bills.

Also keep appealing this. Appeal to the insurance company with as much documentation as possible, then to the state insurance commissioner. Again if there is a broker or agent involved get a hold of them and have them help out to.

Send me a pm if you need more information.

Joe

 

RANT

Insurance companies are not your friend,especialy health insurance. Insurance companies do not exist to take care of you, no matter what the well paid actors tell you on the commercials. They exist for one reason.

The insurance companies will use every and or any loophole to avoid paying a claim or to deny coverage. Some medical centers are demanding a percentage of anticipated fees up front in case of insurance denial, even though authorization has been confirmed. I adhered to every requirement and did my due diligence.

Not as serious as Richard's situation but last year bringing my wife into a scheduled out-patient surgery, after every i was dotted and t crossed, arranged for vacation days for myself, wifes PTO days and re-scheduled work appointments. Show up for the procedure and am informed I must pay up front $1300 before surgery. I knew that my deductible had been met but to the admissions clerk that did not matter pay up front or go home, she says if the insurance pays fully I would recieve a refund. I am pissed but throw it on the plastic, later I called my HR rep and bitch but only get the "we will look into it". About 3 months later I get a check for $800 and change with an explanation that the insurance denied the portion to the anesthesiologist because he was out of network, how the #@$% would I have any control over that. Is it my fault the regular guy was off that day. I hate the bastards.

Richard, may the force be with you.

 

I had a similar issue. Had back surgery and went through hoops to make sure everything would be covered. All went well until 3 months later I get a 3k bill. It was for "an assistant anesthesiologist" and was out of network. Basically, he just stood there and watched...
Talking to the insurance and hospital proved a waste of time.
I took it up directly with my surgeon. I was calm polite, direct and firm when i told him that was unethical to bring in someone out of network when i was out asleep and had no contol over anything. It makes your practice look really bad, as YOU are the one your patients know and would refer to others.
My surgeon agreed with how I felt and wrote it off. Only in fairness.
Had they called the insurance right away to get an preauthorization, the ins would have at least paid some.
Not sure if you went that route, but worth trying.

These stupid medical places need to BE ethical, other than throwing surprise charges at patients and abusing their "collective powers". I am doing the same with my unethical dentist, who has twice thrown hundreds of dollars of surprises to me. Morons.

 

Just wanted everyone to know this was more me venting than anything. A few of you have contacted me to offer some financial help and that was not my attention at all. I do want to thank everyone but I can't accect any help. I'm not in the best of shape but my family is not staving. There are plenty of other people that do really need help.

We have pretty much exhausted my resources with my HR dept , the doc and our phone calls. They refuse to cover unless surgery is needed and its not.

The good news is they are going to let me pay $2500.00 to get the band. I also just sold a set of used tires thay have been collecting dust for $200.00

I have the 66 Caprice on EBAY and anything over $2500.00 it brings I get to keep too. Its at $2000.00 now so fingers are crossed.

 

Good to hear things are moving forward for you Richard, I know some of us Canadians up here are looking at this type of situtation with our brothers and sisters down south with dismay.

 

Richard, you have received a lot of advice. Here is mine. Try some or all the things people have suggested as quickly as possible. If they don't work, use your credit card. It is your daughter's health and something that will have a huge effect on her (and you and your wife) the rest of her life. There is no price to put on that. I have no idea what your situation is with you home but you might consider refinancing it. Rates are very favorable right now and you might be able to do a cash out refi and payoff the medical bills and this one you are facing. An open forum is not the place to discuss this and if you want to send me a PM, feel free to. And trust me, I am not a mortgage broker trying to get you to do a refi. And lastly, you and your wife have had more bad luck than any couple should have. Bless you and your family.

 

Richard,

I've been reading this and just thinking all day trying to figure out what I would do if I were in your shoes. Seems like you got a plan worked out.

Best of luck and keep us posted of how things progress.

regards,

Jamesbo

 

Allan-Al here in KY. I totaly agree with your last paragraph.

 

All will work out. I sold some tires last week and a 454 motor last night. I also made a few bucks on the Caprice I sold on Ebay. I am about 1/2 way to the $2500.00 I need and they will let me pay out the rest. She goes in for 3D imaging next week and then they make the band and will fit her the first week of March. Thank you all for your thoughts.

 

Hello Richard,

I don't know much about your daughters condition, but is it Craniosynostosis?

If so, this website may help you and the family with questions and moral support.

http://jorgeposadafoundation.org/

I hope I'm not out of line by this and if so my sincere apologies.

Best of wishes to you, your daughter and your family.

Mike

 

I am glad to read it looks like everything will work out for you financially.

Your Daughter is in my prayers.

 

No she has Plagicephaly. Its not near as dangerous that that above. We have a friend whos kid had that and had to have surgery.

 

Richard, mt thoughts and prayers are with you and your family. As men I think we would all feel much better taking any condition affilicting our children thansee them suffer for a second. I feel your pain. My son was born with spinal meningitis. Our health insurance paid 10% and we were seated with over $36,000 for his first 18 months. I have seen mentioned on here before, once a partial payment is accepted, hospitals cannot demand one full payment. Fortunately I have changed insurers. In 2010 my son, then 19, was disgnosed with rectal cancer (Excedingly rare in those under 25). I was out of pocket $6,000 for treatments, surgery, and hospitals, while the insurance company paid over $700,000. Unfortuneately we are in for a new fight, as the chemo and radiation have left him with aplactic anemia. I pray for you to have a shorter and less complicated battle.

 

Richard, I am going to suggest to you that you and your wife check with the Scottish Rite Hospital in Dallas. It is operated by the Masons and is a wonderful organization. It is not a charity hopital but nobody ever pays a dime. You do not have to be a Mason to have a child admitted. The treat children with disabilities. The biggest problem they have is they don't have enough patients. It is on Maple Avenue (near the 3500 block I think). I don't know if you daughter would qualify or not but it certainly is worth a call. The care is incredible. Here is the link:

http://www.tsrhc.org/

Most people are not aware of the hospital and what they offer.

 

Sell a car or two to take care of your daughters plagiocephaly medical needs if you have to.
That's my advice. It sucks that insurance providers are bogus in ducking this as a necessity.....I feel your pain.

See if this helps.
http://www.plagiosupport.org/insurance.htm

My son developed plagiocephaly as an infant from sleeping on one side of his head too often.
It flattened out and we freaked out about it. They offered us the cranial molding helmet for
$4500 and I wouldn't have hesitated. The Dr insisted we bring him to a physical therapist and
try to do it naturally first. We got lucky......turns out he had very tight muscles in one clavicle
area and they gave him theraphy til he loosened up and slept with his head a different way.
The problem fixed itself and his head reshaped itself.

I was VERY concerned for my son's well being and living a normal life with a normal head.
But if I didn't have the cash, I would have sold one of my motorcycles or classic cars to get it for him.
I wouldn't have hesitated. Best of luck with the decision for the family.