InfantReflux.Org Forums: Insurance Coverage Letter- opinions !!

Message

   My DH failed to get Cooper added in time to our insurance. We had 30 days, and as you all know, when dealing with a relfux baby, you are a zombie and can barely remember your own name...
Anyhoo- we have to do all this junk to prove he had a pre-existing condition to get him added. Here is the letter I'm going to fax to our DR to get things moving. Any suggestions are welcome, especially if you've had to deal with insurance before...
Thanks,
Tina
Cooper Lavender has been under my care since his birth and was diagnosed with Gastro-Esophageal Reflux shortly thereafter. Due to the nature of his condition, he will need ongoing care and prescription medications to manage pain and esophageal erosion. Immunizations and well-baby exams are critical to all babies’ health, and therefore the need for medical coverage is essential. 

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tklavender Fan Joined: 30 July 2004 Location: United States Online Status: Offline Posts: 412	Topic: Insurance Coverage Letter- opinions !! Posted: 13 March 2007 at 4:53pm
	My DH failed to get Cooper added in time to our insurance. We had 30 days, and as you all know, when dealing with a relfux baby, you are a zombie and can barely remember your own name... Anyhoo- we have to do all this junk to prove he had a pre-existing condition to get him added. Here is the letter I'm going to fax to our DR to get things moving. Any suggestions are welcome, especially if you've had to deal with insurance before... Thanks, Tina Cooper Lavender has been under my care since his birth and was diagnosed with Gastro-Esophageal Reflux shortly thereafter. Due to the nature of his condition, he will need ongoing care and prescription medications to manage pain and esophageal erosion. Immunizations and well-baby exams are critical to all babies’ health, and therefore the need for medical coverage is essential.
	Jackson 6/04 - outgrew reflux by about 4 months, used prevacid 15 mg, nutramigan Cooper 1/07 - reflux, on prevacid 22.5 mg, alimentum RTF Kaylee 6/09 mild reflux Riley 5/10 reflux 22.5 mg prevacid

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ndrose Senior Member Joined: 18 February 2006 Location: United States Online Status: Offline Posts: 4564	Posted: 13 March 2007 at 8:58pm
	Hmmmm....the only thing I'd add is a precise date as to when he was diagnosed with GERD. I could see them reading this and stamping a big old "NEED MORE INFO" stamp on it and then it taking weeks to get back to you or your doctor to provide the exact date. Good luck. I hope he is covered soon.
	Christine LIZA, 1/02 Princess/Tomboy ELIANA 9/03 Genius/Comedienne (silent reflux; outgrew it at 9 months) MYLES 9/05 My Little Prince (reflux; outgrew it at 9 months)
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tklavender Fan Joined: 30 July 2004 Location: United States Online Status: Offline Posts: 412	Posted: 13 March 2007 at 9:15pm
	Good idea, thanks! What do you think about adding something to the tune of "intense stress due to caring for a child with this condition had led the policy holder to fail to meet deadlines for coverage" I don't know how to word this without making my DH sound like a total loser ( sorry honey ). Does adding something like that make it sound like a pity party? Tina
	Jackson 6/04 - outgrew reflux by about 4 months, used prevacid 15 mg, nutramigan Cooper 1/07 - reflux, on prevacid 22.5 mg, alimentum RTF Kaylee 6/09 mild reflux Riley 5/10 reflux 22.5 mg prevacid
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ndrose Senior Member Joined: 18 February 2006 Location: United States Online Status: Offline Posts: 4564	Posted: 13 March 2007 at 9:27pm
	Hmmm.....my gut feeling is that it would not get you much sympathy. Most docs don't even "get it" when it comes to infant reflux and how hard it is on caregivers, namely mothers. Maybe I'm wrong....but I don't think they'd be very sympathetic, but I don't have much experience with battling insurance companies (thankfully).
	Christine LIZA, 1/02 Princess/Tomboy ELIANA 9/03 Genius/Comedienne (silent reflux; outgrew it at 9 months) MYLES 9/05 My Little Prince (reflux; outgrew it at 9 months)
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tklavender Fan Joined: 30 July 2004 Location: United States Online Status: Offline Posts: 412	Posted: 13 March 2007 at 9:31pm
	yeah i think your right... this letter has to go through his employer first and then if they give the ok, there is no issue as far as the insurance covering us. It's the employer in this case that we have to convince. Do you think that makes any difference? It's a large corporation, so maybe they will not care either... I just don't have to wait a whole year before we get a break on paying out of pocket! Tina
	Jackson 6/04 - outgrew reflux by about 4 months, used prevacid 15 mg, nutramigan Cooper 1/07 - reflux, on prevacid 22.5 mg, alimentum RTF Kaylee 6/09 mild reflux Riley 5/10 reflux 22.5 mg prevacid
	IP Logged

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