Isla is three weeks old today and as of yesterday she finally saw her cleft team. Not sure if you remember, but back when I was pregnant we decided on going to CHLA...well, not anymore. We will now be going to Rady's Childrens and I couldn't be happier about that, but it still doesn't mean that I am happy with our Insurance company!
When I was first researching cleft teams, we spoke with a nurse at CHLA that strongly advised me to go with an HMO because it was going to save us a TON of money. I remember specifically asking her if it was going to be hard to get a referral over to them for the treatment of our daughter, and she assured me that no one ever gets denied. I then looked into the numbers, and she was right! It was going to save of thousands of dollars by going with an HMO rather than a PPO, so that's what we elected to do.
This has been the BIGGEST nightmare of my life so far! Here's a little peak into what my life has been like...
- Isla is covered under me for the first 30 days of life (I am contracted with Hemet Medical Group)
- Hemet Medical Group does not contract to any Children's Hospitals
- Because Isla was in the NICU until October 2nd...the insurance company will not allow her to switch Medical groups otherwise her NICU stay will not be covered, but she can be effective as of November 1st.
- I spent two weeks trying to get a referral to see the Dr. we wanted to see in CHLA, with no luck.
- Finally on week three, we got a "temporary" approval from Hemet Medical to go down to Rady's Children's Hospital for a consult...however, now they won't approve any ongoing care and want us to go with their approved hospital Loma Linda
- I now have to file an appeal with my Insurance company so that the care will be covered for the next two weeks, until she is transferred to her own Medical Group (Children's Physicians Group).
- I called to confirm the transfer of medical groups for November and the insurance company did not have the right group selected for the transfer. And because I called to confirm this AFTER their cutoff date, they said that the transfer would not be effective until December now.
- After calling and speaking to probably every single person at the Insurance Company I FINALLY got a hold of someone that actually knew what she was doing and she completed the correct transfer for me.
- Although, Isla is now going to be under the right medical group to see the specialists that she needs...her Pediatrician isn't covered under that group. FML!!!
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