Insurance Update : No Bueno

Earlier today I got an email from Clinic 4 Kidz stating that they talked to Blue Shield and they agreed to cover their services.  I jumped for joy, sent out texts letting our families and a few close friends know the news, I did a blog update with the news, and as soon as I posted the blog update on Facebook I got a call back from the Clinic... umm sorry but that coverage is not what we thought... NOOOO :(

So here's what's going on... BSC (Blue Shield), has said that they will only cover the clinic as an out of network provider and only at their agreed contracted rates.  What does this mean?  The out of network part basically means that we just pay more out of our pockets than an in network coverage would cost.. we don't really care about this part.. but the agreed contracted rates means that, say for instance the upcoming feeding evaluation that we are having on Thursday costs $1500, well BSC says, no we only agree to let you (the clinic), "charge" $200 for this service so thats all BSC will pay, so then the Clinic would then send us a bill directly for the remainder, which in this example would be $1300.  This is NOT okay.

When asked why BSC would not cover it fully at the in network level they said it is because Stanford offers the same services and Stanford is already in network with them.  Well BSC, I've already told you 5 times already that we've already BEEN to Stanford and no they DO NOT offer the same services, they told me themselves!!  So now I am trying to find someone at Stanford who can write me a letter stating that they don't offer the same services, and the services they do offer we've already tried them and it did not help Abby.  UGH this is so stinkin frustrating!!!!

So what now?  Now we have to file for an appeal which can take several months.... The clinic has told us that they will NOT start treatment until insurance agrees to cover their services, which now jeopardizes the July 8th week of when we were hoping to get treatment started.  The only other way around this is for us to come up with $35,000-$45,000 and pay for the clinic in cash.  Yea let me just pull that out of my back pocket! >:(

Today has been a roller coaster of a day and leaving us frustrated, sad, angry at blue shield for not listening to us and worried for Abby's sake... but I know God tells us not to worry, He loves us and cares for the birds of the air, how much more does He love and take care of US.  Be Still and know that He is God... repeat this over and over Nico, no ifs ands or buts.

Continued prayers appreciated as we begin this uphill battle with Blue Shield.

Sad Mama

Here's a picture of Abby to lighten the mood ;)