Insurance Approval

Insurance Approval (of a sort)

Today, I called Mobility Solutions to see if they had heard back from my insurance company. They hadn’t, but they would call and check, and let me know. Just before 5, I got my call back.

The information had been sent to the insurance company last Thursday. And Mobility had a confirmation fax reply saying they had received the query. But, when they were asked about it today, ins couldn’t find my file, of course. 7 hours later, an answer did come through.

Apparently, our insurance company is just managing the account, it’s really a self-insured program with Jim’s employer and the employer sets the rules, so there are some less common twists to how this works. Instead of the ins co pre-authorizing anything, or allowing some things and not others, and instead of itemizing how they will pay for any particular item – it seems that they will pay out up to $5000 per year either per person or per family (this point is still not clear) for whatever durable medical supplies you want. What I don’t know yet is whether my urological supplies counts toward these DMEs or not, but even if they do I haven’t spent more than $500 on DME so far this year. And as it happens, I have enough supplies to last the rest of the year too.

Then the insurance co said that they have some standard arrangement that they will only ever pay 80% of retail for a wheelchair. This means that my chair, priced at around $5400 retail, will get insurance money of $4300. If my urologicals were $500, that means $4500 left, so I’m good! What’s confusing to me, is why Mobility Solutions is ok with this, but that’s because I don’t know how much Tilite is expecting them to pay for the chair before they resell it to me. Still, Mobility seemed to be ok with this arrangement, so why should I complain? I trust Tilite must be ok with it too, or they wouldn’t sell through Mobility. It’s sort of like the insurance co setting their reasonable-and-customary amounts, but being very arbitrary about it.

The most curious part is that the way this is set up it seems I can order anything I want, really high end whatever, and if it’s under that $5000 line they’ll pay. It’s a good thing I don’t want a power chair!

If however my chair were over $5000 then I have to pay the difference.

Tomorrow I’ll call insurance myself and find out how much of the $5000 has been used, but I’m pretty sure there’s at least $4300 in there left. The worst case scenario might be – finding out later that I will have to pay the 20% after all – or $1100. This, I can handle. Well the worst case I suppose will be finding out later they won’t pay at all, but it seems highly unlikely.

Tomorrow also, they are sending me a document I have to sign saying I’ll pay whatever difference is due, plus they’ll send me the final draft of the order for the chair for me to double check.

With any luck I’ll have the order in by Monday, isn’t that exciting! And the waiting starts again.

Now, why couldn’t the insurance company tell Mobility this back in April when they first called for verification? If I hadn’t called Mobility, and Mobility hadn’t called the ins company I think we’d all have waited a long long time for a reply. Which is, of course, the way insurance companies like things.

But, moving on – another step of the process is almost done.

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Update on my wrist – continuing to get better! Every now and then I do something simple and my wrist reminds me it isn’t fully healed. I got some water drips on my hand yesterday, shook it well to get the water off – OUCH. Bumped it going around a doorway – OUCH. And often by the end of the day, it’s a bit tingly. But I’m doing really well with patches once in a while during the day and naproxen sodium sometimes when I go to bed. 2 advantages of the pill - firstly I can’t pull it off in my sleep at night, and secondly that it helps any other aches and pains I have too, and so it even helps me get to sleep. The advantage of the patch in the daytime is that I’m not messing up my stomach 24 hours a day. During the day if my neck or shoulder or elbow are sore, I can live with it. Most days, luckily, the only thing that hurts is my wrist. I have had some days where I haven’t used either medication, so I know overall it’s doing better.


Update on the rest of my life? – Jim was supposed to be traveling this week, but last Saturday while dead-heading roses he twisted his back, and was in a lot of pain in his upper back – near shoulder blade and neck. He did not relish the idea of sitting in a plane for 5 hours (or more) flying to DC, and didn’t know how long it would last or if he might need to see a doctor, so canceled his trip. He’s doing much better now, it wasn’t very serious, but it did change my week a bit. I was looking forward to a lot of time alone to do more writing. I’ve got a couple of other things in the works besides my blog now. I really need to rearrange my life better so I work on higher priorities first.

And I’m in the process of lining up another house project – painting the eaves, fascia and driveway. We’re looking at June or July, and it’ll mean having workers around the house for about 2 weeks. This time though, it’ll be easier on the cats – the workers will be outside!