6/9

I didn’t sleep well last night. I felt out of sorts. I power cleaned at 4 in the morning just to be alone with my thoughts.

Ethan needed his lab work this morning. His rejection medication levels were too low. Then they were too high. We had to go get poked to see if the changes we made yesterday will affect the level today.

The frustrating part is there is a medication that we can get that keeps his level more stable but we are denied access to it.

While waiting, we ran into a fellow NYC heart transplant warrior. We chatted while we waited. We were comparing stories. Both stories unbelievable in their own way.

When we got home I called the insurance company. I was frustrated that there was a drug he could have that could keep things more stable but the company is preventing it. I needed an angle that we haven’t tried using before to help our case. I decided to use an angle that I have used many times while negotiating contracts with companies at work. Cost efficacy. 

I spoke to someone about the cost efficacy of denying Ethan’s other rejection medication. I explained that because of the denial his levels are yo yoing. Because of this denial, they were now paying for two medications, more frequent trips to the lab, more lab tests as well as putting Ethan at risk for more procedures in the future that would cost them money. This doesn’t seem cost effective on their part. I asked if it could be revisited with the medical director. We will see how it goes.

I then made some calls. I have been getting bills from the hospital for things I know we don’t owe. They want me to pay the bills but they don’t want to talk to me about them, only Ethan.  I have to get Ethan on the phone each time to give permission to talk to me. 

Then I have to verify his birthdate, address, phone number, subscriber ID number, date of his last period (just kidding on the last one). Then I have to go through the same set of questions for myself, even though we have been through the proper channels and filled out the paperwork stating he has given permission for them to talk to me. I find it annoying.

Some of these bills I know are in error. I call the hospital. They can’t help me resolve the issue, they tell me I need to call the insurance company.  I call the insurance company and they can’t help because I need more information from the hospital.  I then find out that the hospital needs an explanation of benefits sent from the insurance company.

As I finally start making a small amount of progress, I get the lady at the insurance company to email me an explanation of benefits. I am told the email will arrive 24-48 hours after this phone call. 

What? What kind of  snail email service is this? Since when is it so difficult to construct an email in less than 24-48 hours? Maybe it would be faster if I had gotten it in the mail.

After being on the phone 3-4 hours trying to resolve billing errors, I had had enough. 

I was able to work for a few hours. Get a splash of normalcy. See some cute animals, help them feel better.

Then I got home and had to make a new “sak” for Ethan’s new machine.

Our bright spot was the two men that came and set all of the dialysis equipment up for us. Moving home will be so nice.