Wednesday, January 25, 2012

Insurance Denied!

Brian and I got notified at 3:30pm on Monday afternoon that our insurance provider was denying Madison’s procedure. 

“It’s considered an experimental and unproven procedure.  Current medical studies have not shown that this treatment is safe and effective in children less than 12 months of age, therefore your health plan will not cover the requested service.”

One could imagine the emotions that began to flow throughout…we had been planning for this day since August, and to get notified this late in the game was heartbreaking.  We did our due diligence and found the best surgeon, who is at the forefront of CI surgery, and has even published studies showing the safety and effectiveness of CI surgery for infants this young.

A peer-to-peer (insurance company’s MD speaking with our surgeon) conversation needed to take place prior to 3pm on Tuesday or else the surgery would be canceled.  We tried all avenues, spoke to several people, and tried our best to cut through the bureaucracy at the insurance company.  At 2:30pm on Tuesday, we were cc’d on an email from our surgeon stating, “The surgery has been approved.  Please finalize Madison’s scheduling ASAP!”

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