It was about 4pm when Scott got a call from our secondary insurance company. We have not been in touch with them directly, so it was unexpected. The lady informed Scott that they had denied the doctors letter for special circumstances for them to do Emma's surgery.
Medical insurance in the US is a minefield, maze and obstacle course, surrounding money and health - two things that should not relate to each other! With such a huge country, there are naturally boundaries. We live in Pennsylvania, one of 50 states and it is larger than my country of birth by a long shot! We have two insurance companies: the first is coverage provided by Scott's union. Our contribution for that comes out of his wages. Our secondary coverage is for Emma alone, provided by the state government for her chronic medical condition. The first has always been fairly hands-off unless hospitalization is required, but the second picks up everything for Emma that the first won't! It was our hope the same thing would happen here.
As the doctor we want to use is in New York State, where the companies we have do not have payment arrangements with hospitals (i.e. a reduced price agreement) they do not want to cover it. Understandable,it is business after all, which is so wrong - Making business decisions with people's health, but that's the system we are working with.
They did offer us an alternative, which is to use the doctor at Children's hospital - remember, the surgeon we saw in the winter, who has followed Emma since she was an infant. We decided not to go with him because he had not performed surgery on anyone with Moebius, nor done the procedure on any children.
At 5pm we arrived at a cocktail party in the city.
Medical insurance in the US is a minefield, maze and obstacle course, surrounding money and health - two things that should not relate to each other! With such a huge country, there are naturally boundaries. We live in Pennsylvania, one of 50 states and it is larger than my country of birth by a long shot! We have two insurance companies: the first is coverage provided by Scott's union. Our contribution for that comes out of his wages. Our secondary coverage is for Emma alone, provided by the state government for her chronic medical condition. The first has always been fairly hands-off unless hospitalization is required, but the second picks up everything for Emma that the first won't! It was our hope the same thing would happen here.
As the doctor we want to use is in New York State, where the companies we have do not have payment arrangements with hospitals (i.e. a reduced price agreement) they do not want to cover it. Understandable,it is business after all, which is so wrong - Making business decisions with people's health, but that's the system we are working with.
They did offer us an alternative, which is to use the doctor at Children's hospital - remember, the surgeon we saw in the winter, who has followed Emma since she was an infant. We decided not to go with him because he had not performed surgery on anyone with Moebius, nor done the procedure on any children.
At 5pm we arrived at a cocktail party in the city.
It was a fundraiser for Fred's Footsteps, a great philanthropic organization that provides financial support for families impacted by an illness or injury of a child, until they can readjust to their new normal. They helped us out greatly in Emma's first year and it was our pleasure to go to the 10th anniversary to share our story with donors, and encourage them to keep contributing. It's quite the experience rubbing shoulders with rich people at a cocktail party when you have no money and don't drink, LOL!
The significance is that the group was started in memory of the CEO of our first insurance company, by his wife and children. The bigwigs from the insurance industry were there, and we took the opportunity to ask for help! We are going to see if we can't get our case in front of the top brass at the second insurance company and maybe get their support! A friend in the industry also suggested we get our local state representative (like an MP) involved to lobby for us!
The hope of getting a smile for Emma is not dead, but has been setback. Our original hope of getting the surgery in early August looks highly unlikely right now, if at all - but I am thankful that we have a big God, who can do all things, and often seems to wait until we have exhausted our resources so that there is no doubt when He comes through and makes things happen! We shall continue to hope, move forward and see.
The significance is that the group was started in memory of the CEO of our first insurance company, by his wife and children. The bigwigs from the insurance industry were there, and we took the opportunity to ask for help! We are going to see if we can't get our case in front of the top brass at the second insurance company and maybe get their support! A friend in the industry also suggested we get our local state representative (like an MP) involved to lobby for us!
The hope of getting a smile for Emma is not dead, but has been setback. Our original hope of getting the surgery in early August looks highly unlikely right now, if at all - but I am thankful that we have a big God, who can do all things, and often seems to wait until we have exhausted our resources so that there is no doubt when He comes through and makes things happen! We shall continue to hope, move forward and see.
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