Day 811 - James Has the Sillies 🤪 & Denial from Insurance 🤬

Tuesday, March 21st, 2023

James had physical therapy at the house in the morning and we took him off the vent for it. We tried to get him to practice standing but he wasn't very interested. 

Mom has been trying really hard to remove stress. 🧘🏻‍♀️ But nothing can get a medical mom more riled up than getting a denial from insurance. 😡 Today we received a notice of adverse benefit determination saying that they are not covering James' hospital stay for RSV. The paragraph that this Medicaid doctor typed out explaining the "rationale" behind the denial is ridiculous. "There is no documentation of continued breathing problems after your child arrived at the hospital. Your child got better quickly and went home". Not only did the ER doctor highly suggest getting admitted for overnight observation but James left the hospital on oxygen and has been back on the ventilator since discharge. The amount of text messages, phone calls, emails, faxes involved to submit an appeal is absurd‼️

Mom texted our case manager to see if she could help with this (because the letter suggests contacting your case manager) and she tells Mom to call the phone number on the denial letter. Mom went through a few phone loops and finally talked to the right person, although she didn't speak much English. She suggested Mom file the claim by mail or fax even though the paper says it can be done over the phone. Mom let her know that she was calling because she wanted to get it done over the phone. So she spent about 45 minutes on the phone collecting all of the necessary information to submit the appeal. However the system wasn't working. She couldn't submit it and after all thst asked Mom to file the appeal by fax if we wanted to make sure it gets out through. Let us go dust off our fax machine.

P.S. You can email James your love and support as often as you’d like. Mom and Dad read these email to James as they come in. We all love them! JamesWestonAbramowitz@gmail.com