Playing the Insurance Game

special needs parent Oct 31, 2021

I realize this may be a can of worms, and I empathize with those who have been at this longer than me, but is anyone else out there frustrated with the game that you have to play to get the medication someone in your family needs?

If you’ve been following this blog, you probably caught my post last week about how the book, Hope for the Violently Aggressive Child, had a hugely positive impact on meeting our child’s needs.    Yes, the title isn’t the greatest, but this is why one should never judge a book by the cover.

When we started our journey with this medication, we were blessed to get samples from our doctor.   You see, a prescription is extremely expensive.   And we didn’t have insurance at the time.     Around the time we got insurance we also began working with our doctor on how to approach the bottom of the free sample well.    In addition to being expensive, this medication is also not approved for children.

Which leaves subject to policies and procedures of the insurance company to determine if we can get this medication approved for or son.   While, thus far, they have been very understanding when I have spoken with them, I would guess most of them have not walked through the parenting journey we have and don’t fully empathize with why getting this medication matters.

Two days ago, following last weekend’s meltdown, we found out that the our kiddo’s medication was approved.    (insert sigh of relief)  Except it’s still crazy expensive!  And now we have to begin a new appeals process to get a lower price approved.  Once again, our insurance company has been helpful in explaining the process and our doctor has been more than accommodating, but you know what dawned on me today…….

I’m not allowed to do this appeals process to get the cost of my child’s medication down.   My doctor has to do it.    My doctor who is not intimately aware of our financial circumstances and an insurance company that knows even less.    I don’t know if they will ask us questions in the process, but given that the medical side of it is already addressed, it seems that it would make a heck of a lot more sense for the next round of appeals to go through the client.

Has anyone else ever dealt with this?  Do you have any sage wisdom to offer?   Do you just shake your head in awe an wonder our our medical insurance systems sometimes?

I do.

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