Jo continues to be at Children's hospital in Seattle, receiving exceptional reahab care, despite the continuous ridiculousness of insurance denials. It is both infuriating and extremely sad to see the games they play even in a case like Jo. You'd think that if it was fraud they were worried about they'd chose another case with less obvious need. It really has nothing to do with the case, the patient, the circumstances, or any other human factor, it's pure greed. In the past year, and in previous years dealing with Jimmy's medical needs, I can factually prove one undeniable fact; The first step in any insurance claim is denial. The insurance company hopes you will miss a deadline, be too busy caring for your loved one, or too distracted or distraught to follow their bureaucratic laborious appeal process. They hope your caregivers are too busy to fight for you, that you will give up, and that all these expenses will just go away. In our case they hope we will give up and turn to Medicaid, costing them nothing.
Jo's pharmacy has been denied. Jo's in home nursing has been denied. Jo's in home PT and ST have been denied. Jo's nutritional needs have been denied. The best one yet his in patient rehab was denied 2 days ago (he's still there). Each denial requires its own separate appeal within 30 days. The clock starts the day they make the decision not the day you receive written notification, and that can take up to a week. There denial letters read like a supreme court justice opinion on case law but typically end by saying, he doesn't need it, it is not a medical necessity. The most recent letter denying his home nursing ended with, "The Physician involved in making this decision may also be reached at 000-000-0000".
We have a case manager who really does care, and she really tries to help, but even she has admitted I know the process better than she does. She can't believe that everything I've said would happen has happened exactly as I described. She isn't even allowed to discuss the reasons for denial and cannot connect me with anyone who can. The only person who can talk about the denial is a Dr. caring for Jo. They can "compare notes" and "clarify" Jo's condition with the hope that the medical director will reverse their position. They will only do that if it costs less than approving the request. So if Jo didn't have a nurse they want to know how likely it would be he could end up at the ER? What damage could be done without a nurse nearby that may cause a hospital stay to recover? Why can't mom and dad handle it? I'm not joking, these are really what they ask! Thank God we are surrounded by people who are more than wiling to take up arms to get this fixed, I'll close my rant by saying, none of this will deter us. Jo will get EVERYTHING he needs no matter the process, God by our side we will prevail. Enough negativity for one post, thanks for listening.
Jo had his medicine pump procedure on Saturday and his recovery was extremely difficult. He was in a lot of pain through Monday. The pain has subsided now but it was very difficult to see him so uncomfortable, it brought back many painful memories from his time in ICU. We are so glad the worst is over, and the pump has really helped his muscular issues, and it is clear the short term pain, will have a long term gain in his recovery.
Despite what Aetna thinks Jo will be at Children's for at least another week. It leaves us with more time to argue and fight for what he needs, we will get it done. I am certain that the Drs who are caring for Jo are far better suited to describe Jo's medical needs in a "peer to peer" setting and Aetna's mysterious Kirk Shamley "medical director" will relent and agree to provide what Jo needs. After all his decision wasn't based on any of Jo's conditions to begin with, it was based on money, and to him Jo's not a boy on the road to recovery he's a number and an expense. Aetna is playing a game, taking the odds that we will give up, they will lose. I honestly don't know how this guy sleeps at night, it is truly amazing. I'll update when we know more, but for now pray for us, pray for Jo, and pray for the people at Aetna towing the company line despite its impact on families like ours. Forgive them for they know not what they do.
Jojobinks your strength inspires so many people to never give up. We will never give up in getting you what you need. We know someday you won't need any of it but for now rest easy WE'VE GOT THIS. They don't realize who they are dealing with, and who we are fighting for. Stay strong, rest and heal with God by your side, keep the miracles coming! We love you to the moon and back sweet angel, YOU'VE GOT THIS!