Wednesday, April 7, 2010

Are you REALLY in charge of YOUR health Care?

We see A LOT of doctors for Tyler. The course of action for a child with cerebral palsy really doesn't vary by TOO much. Meaning there are only a few things that you do as treatments.

Treatments depend on the Type of cerebral palsy that you have or are treating so the ones I know about is Spastic diplegia. Which is the type that Tyler has.

Most spastic kids are treated with Botox and then escalate to other things. We have gotten phenol and at some point we will need the next step.

Last time we were in the Physical Rehab docs office she said that they would like to do botox in a few spot on Ty's arms and phenol in his legs. She said " I need to go see what your insurance company will cover before we make a treatment plan."

RED FLAG: If our insurance doesn't cover botox ( which they require an appeal) then we can't treat him with that because our insurance won't cover it.

Even if it is the course of treatment he needs if the insurance decides they don't want to cover it the they don't. That means I am not in control of his health care.

Today, I had my own "insurance" issue.

I was taking the depo lupron shot and the pharmacy that provided it to my docs called last week and was setting up my next dose.
We went in today for that dose. And they were ready to give it to us. Instead we opted to be in control of our health care and between Dallas, our doc and Me we opted to not take he second shot.

When we got home, we got a call from the pharmacy and they said that they weren't going to be sending the second shot because we have a balance on the first shot. I explained that we have the rebate from the makers and it is a 85 dollar rebate leaving the bill 15. They wouldn't send my second shot for 15 dollars. How are they in control of me getting that shot. Is it NOT me and my doctor and MY body?

I was medically in menopause. They needed to keep me that way for another 3 months but if I can't afford it then I guess my body goes back to being sick. Incredibly sick.

It seems that the insurance company and the people who are determining our health care. Even if we are needing that service or not. We seem to just not be able to get it because we can't afford it. So should Tyler NOT be given botox because our insurance doesn't think it is a good idea but his Doctor does?

How are you in control when they are determining what they cover?

PS. according to the pharmacy that provides the shots to my doctor, the shot he had ready and drawn up for me "must have been a sample" and they have no idea where he got something to give me. Which means that the shot was 7 grand and no one knew where it came from. HMMMMM

seems a little odd?

*did you read that.... we didn't get #2 shot*

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