A weight has been lifted. Many of you don't know that I have been battling with our insurance company since the end of 2016 to get more therapy visits covered for Ezra. As a parent of a medically complex child, we see specialists from practically every rehabilitative sector: physical therapists, occupational therapists, speech therapists, dietitian, audiologist, chiropractor, etc. I have learned that within every discipline there are therapists who have specific expertise in different areas. We have been fortunate enough to be connected with therapists who share the same title but have unique and relevant experience to help Ezra. For example, we see several Speech Pathologists. One of them is part of Ezra’s Cochlear Implant Team and specializes in therapy for children with hearing loss. We also see a Speech Pathologist who is part of Ezra’s Cleft Palate Team. The third Speech Pathologist we see is part of our Feeding Team. I consider each of these therapies to be distinctly different and vital to Ezra’s progress. That's what I was trying to communicate to our insurance company. Our policy provides exceptions for certain "chronic conditions" and my claim was that Ezra's diagnosis should fall under that category.
This 6+ month conflict was such a slog. It involved so many hours on the phone, waiting on hold, getting transferred around to different department experts, acquiring letters of support from Ezra's therapists, explaining our unique situation, defending the medical necessity, petitioning to defer payment for services, paying for visits to avoid collections, receiving denial letters, feeling frustrated by contradictions in the health system, advancing to higher levels of appeal...it was a LOAD, and as a non-complainer, one that I held privately. A few weeks ago, I argued Ezra's case to a panel of doctors. It is the highest appeal option and that ruling is final. We won. I got the call today. And not only did they retroactively approve his therapy visits for 2016, they are giving him unlimited therapy visits the rest of this year. They told me his case was the first to successfully appeal under the "chronic conditions" exception and that they would be looking into the policy language with their lawyers to see what modifications could be made so that we would not need to appeal for services in the future.
I'm going to love not thinking about this anymore.
So much effort. So much relief.
Go Team Ezra!
