Insurance Idiocracy

..A little look into my frustrating few weeks of this wonderful new year so far...

Unfortunately all Shands employees were made to switch from Humana to a new insurance starting Jan. 1. I pay more for the PPO option because 98 percent of Lucca's doctors are not at Shands because they are specialty doctors, and we obviously have to go to them lol.. Well as you all know Lucca has been going to therapy at Wolfson's since last March,...never once have we had an issue with his insurance.. So we go Jan 3rd for his PT visit and the clerks tell me that UMR (the new insurance) is saying that they do not cover Lucca's previous diagnosis of "developmental delay" and that I need a referral... First of all, I am paying BOOKOOS of money every paycheck to have a PPO out of network plan so I do NOT have to go through the whole referral process everytime we have to go to a new doctor... and second of all, 95 percent of kids are going to therapy because of SOME kind of developmental delay!! How the heck can they "not cover it." Anyway, so I have been going back and forth with therapy, insurance, and referrals about whether or not I need a referral, and whether or not I am covered and how much..for 3 weeks now! RIDICULOUS!! So when one person calls and says everything is fixed it should all be ok, the other one calls and says the insurance is telling them something different. UMR was telling therapy that I needed a referral and then telling the referral person at Lucca's PCP that we didnt.. lol OMG talk about utter frustration!! I called UMR last week and the lady told me that I didn't need a referral and I would be covered 70 percent but if I got a referral that I would be covered 100 percent, so duh of course I'm gunna get a referral! who wouldnt!? SO again, I call the referrals lady ..who calls UMR..(again) lol and calls me back saying "Mrs. McLendon, they are refusing to give me a referral because they are saying that you are covered 100 percent already so lawfully they can't give me one" SOoo I call therapy and tell them that lol.. Still not knowing which one is entirely true.. Well I find out yesterday that I need to make an appt with Lucca's neurologist (who is at Nemours) and I call and what do you know, they say that they don't take UMR...lol So of course I am about to have a mental breakdown because that is where ALL of Lucca's specialty doctors are located!! How can you tell me you don't take my insurance?! lol (see my frustration with this stupid ongoing cycle) So a friend (who is having similar issues) and I went over to talk to Human Resources today and basically complain and then find out what the heck is going on and she told us that if Shands doesn't offer a service (i.e. Pediatric Neurologist, Therapies, etc) and we HAVE to go somwhere else, that insurance HAS to cover at 100%! YAY! FINALLY someone who knows what they are talking about and is sure about it! I ALSO find out, that last year that I was with Humana PPO that it was the same thing, I should have been covered 100percent and they were only covering 70 percent so I better be getting some money back because I am STILL paying on last years bills!! Hopefully I will get that situation figured out but at least NOW (after 3 weeks of missed therapy) I know for sure what is going on! Hopefully we don't run into anymore issues! :)


((p.s. A day after I wrote this post, we started having the same insurance issues all over again...apparently no one has heard of UMR and they are giving all Shands patients that don't go to Shands huge problems...sooo frustrating!!))

Therapy Updates

Lucca had a GREAT therapy session yesterday with his PT Ms. Debbie. He has a weighted compression vest that we bought him to wear that helps weigh him down some and helps with his low muscle tone.. (hard to explain exactly what it does, but it helps him balance better and gives him better "input"). Anyway, he wore it the whole session yesterday and she said he had one of the best sessions he has had in a while. He was sitting up great and doing pushups and picking up his legs to walk.. and as a treat he got to go on the little trike they have there! He was so cute!

(his little vest looks like a bulletproof vest lol)

Then his therapist called me this morning saying that next week he is getting fitted for orthotics. (ankle braces) to help keep his feet from rolling in and turning in when he is weight bearing. So that is exciting! ALSO since Lucca sat up for the first time on Sunday, he has been doing it almost every time he sees his beads! I took another video of him yesterday sitting up, just because I am so proud of him and want to share it with the world!! It is such an accomplishment for him!

Positive News and an Exciting Week/weekend!

As you can see in my previous post, Lucca's therapist has been using a walker with him during his PT sessions... My dad and Randy decided that wanted to both pitch in to buy Lucca a similar walker for at home...When I brought that up today at therapy she said "I don't want you to think that just because I am using a walker for him in therapy that he is going to need one long term. I am merely using this as a stepping block for him, but he is already showing the steps and signs that he is going to walk just fine on his own..it will be on 'Lucca Time' but he will walk on his own." How EXCITING is that?! Definitely a sigh of relief if this is true. =) Of course that is not WHY we were wanting to get one, we thought by getting one for the house that he would be able to get this type of exercise EVERY NIGHT instead of just one day a week and hopefully that will help him progress even better/quicker!

Last Friday was the Seniors last day of Radiology School =( Quite sad to say the least.. Happy for them too, but still sad. This is the first class that I have actually built friendships in and some of them are leaving and moving away, and others are not getting jobs at Shands so I hope that I will still be able to keep in touch with some of them. They are some great girls =) But they have slaved for the past two years like I did when I was in school, so I am excited that they are FINALLY graduating this Thursday night! Congratulations Class of 2010!!! I love yall!

Also on a good note... Randy surprised me yesterday saying that I needed to start packing for a birthday vacation weekend! He won't tell me where we are going, just that we are leaving Saturday morning and coming back Monday afternoon =) I'm kinda excited and nervous at the same time! Can't wait to see what he has planned =)

Lucca @ therapy

Nothing really to post today... Just that I am trying so hard to stay positive about Lucca's diagnosis, but it is so hard when I see kids his age and younger walking and talking and singing..etc.. I know, I'm being a Debbie Downer.. not trying to be.. some days are just harder than others. I know he is progressing, which is awesome...I just wish the best for him that's all... On a good note.. Here is a video of Lucca @ therapy on Monday and one of him this weekend standing against the couch. He is definitely getting stronger =)

Physical Therapy Update

Lucca's PT said he has been doing so well and she can tell he is getting so much stronger =) This is such a blessing to hear, especially at this point in time... He has been going since March and has progressed SOOO much since then...

Here are a few pictures we have taken of him in therapy:

[Kinda blurry, but he LOVES LOVES LOVES this swing!!]

[Learning how to walk =) ]

[Always with the binky in the mouth hehe..]

[On the trike]

[Again on the swing..workin on his pushups!]

Physical Therapy

We go to Lucca's Physical Therapy Evaluation at 10:10 in the morning. Hopefully we will hear encouraging news! Wish us luck!

Physical Therapy

Physical therapy is a go for lil man hopefully! We go March 15th for his therapy evaluation and I gues THEY decide whether or not they think that he needs it? or to what extent he will need it? Anyway, just pray that it helps! Thanks!