...the insurance battle continues...
We've been fighting with the insurance for a year now. The doctor's office warned us that getting insurance on board would be a chore and it definitely has been. We've jumped through their hoops with very slow progress. In March they granted us what is called a Gap Exception which allows us to see our out-of-network doctor. They gave us until July 1, 2019 to have the surgery complete but that was an unreasonable timeline (because she needed a surgery in preparation for this surgery & we are missing a document) so we filed for an extension to December 31, 2019, which was eventually granted. The original plan was that she would have surgery (in LA) in September but clearly that has come and gone without surgery.
We get asked all of the time where we're at...so, here's the scoop...
We have everything we need to move forward but one single document called a Letter of Agreement. Without that document we will be "balance billed" for the procedure - meaning whatever the insurance decides not to cover will come out of our pocket. For example, if the insurance decides they will only pay $5,000 we will be left with any balance above and beyond that, aside from the very large sum of money we will pay upfront - potentially leaving us bankrupt. So...we wait for said document.
We've been fighting for this document for many months now. After a lot of headache we were granted a Case Manager through the insurance company, which made a world of difference. Lacey has been wonderful to work with and to put up with my almost non-stop phone calls - hey, the squeaky wheel gets the grease. We talk frequently and have developed a very positive relationship and we are very grateful for her advocating on our behalf. With the end of the year fast approaching and the surgeon having very limited dates available, I have done my best to keep our case at the top of their pile. Poor Lacey is just stuck in the middle, but oh man am I grateful for her.
Long story short...for the last several weeks this document has been "pending". Today we got word that our request has been DENIED.
So what does that mean?!
1. No, Kambri will not be having surgery before the end of the year.
2. No, we don't know if or when we will be able to move forward.
3. Yes, we will need to again file for an extension into next year.
4. Yes, we will file a member grievance and see where that road takes us. We're not giving up yet.
We don't know when or how (or even what) the future holds but we're doing our best to hold on, be patient and remember that God has a plan.
