Tuesday, May 31, 2011

Getting Authorization

Oh my goodness: it is finally WARM outside!

I finally managed to get hold of the financial services department at Cleveland Clinic. Our insurance company won't approve a visit to their genetics department until Nolan's primary care doctor writes an authorization to the insurance company (providing all medical records). We're in the process of getting this squared away.

We haven't met our deductible yet, so we will pay out of pocket for most of the costs. Still, it would be nice to have our insurance company cover whatever exceeds our deductible. Since the Cleveland Clinic is a world-class facility, we have great confidence in their opinion. If they say that there is nothing underlying Nolan's hearing loss/severe reflux/fatigue/urology issues/apnea, then we can relax and do the fundoplication surgery.

It can take 30 days for insurance to approve the visit once our pediatrician sends in the authorization, then we will have to book an appointment. At this rate, it is likely we won't get to the Cleveland Clinic until August or September. We could just go to our local children's hospital, but we don't have the same confidence there. We've been told that two separate surgeries would correct Nolan's apnea issues, and neither one has "fixed" his problems. Anyone could see why we're a little dubious about a third surgery, intended to "fix" the apnea. And why we are concerned that something major has been missed, since normal almost-four year olds haven't had so many surgeries (four sets of ear tubes, tonsillectomy and adenoidectomy, posterior urethral valve ablation, supraglottoplasty, upper endoscopy, bronchoscopy... and now recommended for a fundoplication). Typical four year olds also don't wear hearing aids and glasses, and need a machine to help them breathe at night.

I deeply hope our insurance will approve the visit. It will either let us rest assured that nothing is seriously wrong with our boy, or will shed some light on why we have been spending so much time in various doctor's offices.


Terena said...

even though it's complicated, it's always best to go with doctors you trust. I drive Queen Teen over three hours to Stanford rather than saving an hour to San Fran. I trust Stanford. Bottom line.

keeping fingers crossed the insurance company comes through

tammy said...

Oh I hope the insurance works out for you! Keeping my fingers crossed. If they don't, I wonder if you can talk to the Clinic (or even Rainbow Childrens - part of University Hospital in Cleveland) about any studies that may be going on? Maybe a possibility of getting it done for free through a study? Not always exactly what we want to do as a parent, but just a thought. We looked at one for EVAS to get extensive genetic testing on Aiden (because it's not always the EVAS that causes the hearing loss ... and there's still so many unknowns that go with it and our insurance wouldn't pay for any testing). We couldn't go through with it though due to our move.

rouchi said...

hat a whole load of issues faced by this lil child.Its really not fair.I agree, there are days I question too,how many kids face issues,when you face one after the other.I really hope all your issues get solved and the insurance comes through.Sending you wishes all the way and hope all the prayers you have for him are answered.