Thursday, September 20, 2007

A busy day and insurance woes

Today we stayed busy all day and I didn't have time to take a single picture! (sad) I just didn't get a chance. Cainan had a much better night last night. He only woke up once around 2am, and was fussing, so I decided to give him some Tylenol, and then I didn't hear from him again until 6:15. So we were pleased. And his disposition was 100% improved today due to getting enough sleep. He still fell asleep in the car when we went to get Arlington from pre-K, and took a 2 1/2 hour nap this afternoon. He is still catching up! We saw more smiles from him today, which was nice. We are still "meanies" when it comes to eating, though. He just doesn't want to sit and be fed! It is a real struggle, and he cries so hard, and fights and fights. But he must eat, so we have to hold him. It is awful. And he sweats so bad when he cries - that isn't helping his heat rash! He only wants to take a few sips of his drink and a few bites of his food, and then be off and running. Then 10 minutes later he is hungry again! We don't play that game in our house. We are firm believers in eating all of your meal at a sitting, and then going to play. It is what we taught our other two, and Cainan will learn the same. We don't "snack eat". We have meals, and then snacks! :) So it is struggle for him. He was doing SO WELL before the surgery. We are hoping that once next week comes and he is back to his regular diet and feeding himself, he will be happier about the mealtimes.
Otherwise, his day was better. He is now walking all over the place. He is really amazing! And his crawl has perfected. We are so pleased with his progress.
The one down side to today - INSURANCE COMPANY. I got a call from the center that is going to do Cainan's therapy. (which he starts next week). They told me that when they spoke to the insurance company, the insurance company told them that since Cainan's problems weren't due to illness or injury, he wouldn't be covered. That includes SPEECH THERAPY. Huh????? I was just told three weeks ago that it WOULD be covered. So I called the insurance company and got into a heated discussion about Cainan's cleft lip and palate and how could they NOT cover Speech for such a disability. I have a 15 month old that doesn't speak a word, and he doesn't qualify? Are they serious? But they held their ground. "It is a birth defect, not an illness or injury, so we won't cover it." So wonderful. I know for a fact that Florida has a LAW that says insurance companies MUST cover speech therapy for cleft lip and palate kids and can't deny it. I called the head of the human resources department of Mat's job to discuss this with her. Here comes the BEST part. Mat's insurance that his company purchased is SO CHEAP that they got written under a federal law clause that protects them from having to follow state laws. We were told that this keeps the insurance coverage down for THEM - not Mat neccesarily - the COMPANY. I commented on how unbelieveable that is that my son can't get what he needs due to them being so cheap. That it is completely ridiculous. Mat is furious. We are probably going to have to pay out of pocket, and it can be very expensive. But he MUST, MUST, MUST have speech. We were told to submit everything we can from the pediatrician and the cranialfacial specialist to the insurance company and they might cover it. But not to hold our breath. Wow, if we can't get speech, who can?
Anyway, I am done rambling. I am just trying to do right by Cainan. Another reason to hate FLORIDA!!!!!!!!!!

7 comments:

Elaine said...

Ugh, the insurance companies are just the WORST. I hope and pray you will get the help with speech. You and Mat are amazing and I wanted to tell you what a great job I think you are doing! Cainan is going to be so grateful to you in the future and, despite his surgeries, seems like a happy baby with you as his family!

Hang in!

Crystal said...

Check into the local resources adn see if there is someone that could come out for a discounted rate. I know when i had Cassandra there were all kinds of resources that were available to help with developmental problems. Check into it, and see what you can find out. Surely someone knows something that can help you out!
Keep your head up it'll get better!

Crystal

Donna Kay Moore said...

What a bummer! Some insurance company practices are so devious and dishonest, it's crazy! Birth defects should not be excluded for any reason! I'm so sorry.

Come move to Texas...maybe it would be better here and then you wouldn't have to be my long distance friend any more! :)

Anonymous said...

Don't we just LOVE these muckity mucks that will screw us every chance they get. Nanny

E R I C A said...

Jeez! Insurance companies are awful. I should know...I was a claims adjuster for a large insurance company for 11 years up until 2 weeks ago.

Don't give up. Keep fighting it. It just isn't fair.

On a positive note, Cainan looks better and better each day. I can tell that the swelling is going down.

Hang in there. You guys are doing a great job :)

Erica

Emma's Journal said...

I feel for you on the insurance mess. I myself can't stand insurance companies....there willing to take your money, but not EVER willing to help. Everything has to be an insurance issue, gosh for your home - hail insurance in Florida.....joke or what? Cainan looks wonderful, and don't give up, you will get the help you need.
Sherri

Suzie DAley said...

Have you checked into any state assisted programs? We live in Vermont and therapies are free to all kids in need to age 3 (regardless of income). You probably already checked into it... just wanted to see if I could help.

Suzie Daley