Wednesday, November 5, 2008

November 5

Today Mama has been frustrated to the point of tears all afternoon. Audrey, the lady who handles Paysse’s payments, called me early this afternoon saying your surgery was going to be canceled because of financial reasons. Since the financial counselor is trying to get the hospital to accept you out of charity, the first step is to apply for Medicaid and be denied. Then the hospital decides whether or not to eat the cost for their portion of the surgery. We would have to pay the doctor her fee of $5000 out of pocket, which is a ridiculous amount of money for 45 minutes of work. Still we would still save thousands and you would hear no complaint from me. However, Paysse said (through Audrey of course--she wouldn't take the time to talk to me about this personally) she didn't want me to have to pay for it out of pocket if Medicaid fell through. I don’t understand her reasoning since when the Medicaid falls through I will without a doubt have to pay at least the surgeon’s fee. What is the alternative? Not have the surgery and let you go blind? So basically what she means is she doesn't want to risk not getting paid by me when we get denied Medicaid. I asked Audrey when she thought the financial decision would be made by TCH and she said by the end of the week. I was willing to postpone the surgery until next week in order to let all of this get straightened out (but not with the happiest of hearts).

The problem came up when I was told the next surgery spot available is December 4th. A whole month away! If we wait that long you will be 7 months old by the time we get you in contacts and actually seeing something. That is just not acceptable. I explained to Audrey how money isn’t the issue, that you have at least three grandmothers who would send Paysse her fee in a heartbeat. Timing is the issue and as it is I am annoyed that it took us 6 weeks to be scheduled for a surgery that should have taken place 3 months ago. I then offered numerous times to pay her today for tomorrow's surgery and she (through Audrey) refused every time. Apparently there are laws against surgeons accepting money from those who may be eligible for Medicaid, so with that ball rolling I couldn’t just pay her up front. I absolutely understand her not wanting to get in trouble with the government. What I can’t understand is why she wouldn’t just go ahead and do the surgery, knowing that I was so willing to pay her up front and that I would pay her as soon as allowed. Audrey worked hard for us and approached Paysse with our case at least three times I know, but eventually came back and said we can’t make her change her mind. I would think a doctor would be compassionate enough to give an infant every chance at vision she could, especially an infant with numerous other obstacles like you. I just can’t believe she would make you suffer for selfish, not to mention illogical reasons.

So I called our financial counselor, explained why they wanted to cancel our surgery and asked if it was legal for them to refuse you the surgery. She told me the surgeon is within her rights but that we had not officially applied for Medicaid yet and if I wanted to drop the application process I could pay for the surgery myself. I asked her to call Audrey for me so she knew she could accept my payment and was put on hold. When she came back on the line she very apologetically said they had already given my spot away and nothing more could be done. After I spoke with Daddy (who like me had been on the phone for the last two and a half hours trying to straighten this out), I wanted to call Renee and insist she get our spot back. But by then it was 4:30 and business hours were over.

To top it all off, we have been ready to reverse your ostomy for the past 6 weeks but were giving your eyes precedence (under the assumption they would have been taken care of long before now). Just this morning I spoke with Dr. Kim and scheduled the pull-through for December 5th. Now, with a December 4th ptosis surgery, the colostomy has to be rescheduled for Dec 23 (we would be in the hospital over Christmas) or January. By the time it is said and done we will have waited a total of 3 1/2 months to reverse the colostomy because of this ridiculous ptosis surgeon.

I am looking for a different surgeon tomorrow who will maybe put some urgency on our case, get us in more quickly, and treat you more like the sweet baby you are than a business transaction. If I can’t find someone to do the surgery more quickly we will stay with Paysse despite my bad attitude with her bad attitude. Your eyesight is too precious to put this procedure off any longer.

4 comments:

Anonymous said...

I know how hard this must be dealing with these doctors and the insurance companies, wanting them to do what is best for sweet little Audrey. I will continue to pray for you in this battle and ask God to lead you to the right doctor and right timing for Audrey's surgeries.

Kira said...

Amber, this is unfair corporate BS that takes the art and science of compassionate medicine and makes it all about CYA and cold hard cash. If and when you do get the surgery make to sure to look that Dr. up on one of the online doctor review websites and write about her lack of compassion and the situation she has created for your special daughter which cost her precious time and hopefully you can save someone else from suffering as you have and they will find a different doctor. Behavior like that is INTOLERABLE in a field where empathy and the desire to heal should come first.

Hollie said...

Amber-
I am so sorry to hear all of the RED tape you are having to go through. This makes the process even harder to bear. We are praying for you and you family, once again!
Hollie, James, Emma and Lillie

Rachel said...

Amber
Audrey should absolutely qualify for medicaid. My daughter got Medicaid based on her disability through the Division of Developmental Disabilities. They base the decision solely on the childs disability and childs income. I have documentation from Dr. Opitz stating the need for state services for children with SLOS. If you think something like that would be helpful let me know I could send it to you. I am so sorry you are dealing with so much red tape as well as trying to do the best possible thing for your baby. Please let me know if I can be of any help! Rachel (helgesonhappenings.blogspot.com)