Tag Archives: UnitedHealth Group

Parenting, Tuberous Sclerosis

Walking for a Cure and Trying to Employ My 14-Month-Old

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I’m still here, even in the midst of all the awesome guest bloggers I’ve had so far this month for TSC Awareness (still accepting guest posts). You might remember me from such posts as Bite Me, United Healthcare or Bite Me, Medical Billing Department That Won’t Call Me Back.

The last week has been really busy. I’ve been doing some freelance writing, which has been immensely rewarding in all ways but financial. But if I keep it up, I’ll have that Italian villa by the time I’m 127. I write for the parenting and education divisions of an online media company. No seriously, I write about parenting in, not one, but two locations. Makes you rethink your Google searches, huh?

The Georgia Step Forward For a Cure took place on Saturday May 18 at Marietta Square. So far it has raised $70,000 and counting–thank you Dee and Reiko for organizing this year after year. I was also named as the new chair for the Atlanta/North Georgia TS Alliance, which I’m pretty excited about. Sarah, a reader who has been following along with the guest bloggers, asked me if I would be there. I told her to look for the obnoxious yellow shirts. She found me.

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Connor is doing well; he’s still progressing, although it can never be fast enough when your kid is delayed. We just hit 14 months, and we’re hoping he’ll crawl soon. He can hold the position if we put him in it, it’s the moving part that is the problem. He can move backwards when he’s on his stomach. The problem is, he doesn’t ever want to be on his stomach. He will expend more energy trying to flip himself over when I have him wedged in on both sides, than he will to move a couple feet. He can also stand with minor support, but again, we have to put him in the position. He doesn’t pull himself up yet. I’m also desperately hoping to hear some consonants soon. He has mastered uh, and quite frankly, at this point he can add a ffff and a kkk and I’ll be the one parent that’s thrilled.

We recently increased his meds when it seemed some sort of seizure activity was breaking through again. It helped, but I still occasionally see his eyes go up and linger a few seconds, or he’ll stare off to the side with tightly pursed lips. They don’t seem to have a lingering effect like previous seizures though.

His delays do seem to have created the very player of son I swore I wouldn’t ever raise. I’ve never formally announced his health issues in music class, although I also don’t hide it. Some people have become aware as the music teacher is also his music therapist, and they have overheard us talking. I also wear my TSC shirts to class. But some may actually believe that I am such an incredible disciplinarian, that I have actually trained him to never leave my side (easy to believe when you’ve never seen him try to empty his entire bottle into his belly button). So there he sits, very cool, very “you come to me, I don’t come to you.” And the girls, oh yes, they crawl right over. They can’t help themselves. He’s so James Dean, if James Dean traded his cigarettes for music sticks.

I’ve also been looking into just how young kids can start gymnastics because it would be a shame for Connor to ever lose the ability to do this:

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We might be looking at a career gymnast. Of course, he has also shown an interest in dentistry.

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And Salvador Dali impersonation.

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Parenting, Tuberous Sclerosis

Dear United Healthcare, Stop Being Creeps

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I haven’t checked, but I’m guessing mental healthcare is not well covered by my insurance policy. I assume this as United Healthcare is currently trying to push me over the edge, and clearly they don’t plan to foot the bill.

United Healthcare has denied our appeal of their denial of Connor’s helmet. Apparently, while some devices are covered, this helmet is an orthotic device intended to “change the shape of the body” and is specifically excluded. Soooo, it’s just a silly fashion statement I guess. Chris and I are just so ashamed of the flatness of the back of Connor’s head that…oh, no, wait a minute. His head shape didn’t particularly bother us. His neurologist recommended it, wrote the prescription, and his physical therapist and pediatrician concurred that it was good idea. Well, I’m no doctor, but I’m guessing they would have told me to buy him a hat at Target if they were just trying to create the new Gerber baby.

So here we go. Appeal number two, complete with letters of medical necessity. Bite me, United Healthcare. Thank you for continuing to waste my time. I also spoke highly of you throughout 2012 when Connor’s medical bills hit somewhere close to $400,000. Sure, we hit the out-of-pocket max and that sucked. But somehow, when looking at six-figures, a standard in our twisted healthcare system, $7,000 suddenly feels like pocket change. Even when I’m no longer working.

But  now you’ve left me focused on this $3,000 “fashion statement” and our substantial premiums we pay every month.

I found this as part of your Mission Statement on your website. Check it out:

Compassion

Walk in the shoes of people we serve and those with whom we work.

We believe:
In order to achieve the full potential of our enterprise in its purpose, to Help People Live Healthier Lives, we must fully understand and align with their needs and realities.

We value compassion:
We will walk in the shoes of people we serve and those with whom we work. We celebrate our role in serving people and society in an area so vitally human as their health. We must be truly compassionate and genuinely understand, feel and identify with their needs.

We behave:
We will actively listen to fully understand and genuinely empathize with people’s realities. We will then respond in service and advocacy for each individual, each group or community, and for society as a whole.

And may I add one more part? We will not add stress to the lives of people who have family members with chronic illnesses and health conditions.

You can help with this further by paying our doctors and hospitals in a timely manner. I don’t why it took almost a year to pay our neurologist for some of his services. I don’t know why when Connor first came home from the NICU, I received repeated phone calls from the hospital to call you and find out why you weren’t paying up. I didn’t need that.

Thanks and have a compassionate day.

Accredo Pharmacy Problems, Parenting, Tuberous Sclerosis

Why, why, why is it so hard to get my child his medication?

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I am an incredible multi-tasker. I am currently writing this blog, on hold with United Healthcare, and having a mental breakdown. Congratulations! You f*&^%$# finally made me cry. I’ve been pissed. But you hadn’t made me cry yet. That took a conjoined effort of United Healthcare, Optum RX, and Accredo Pharmacy.

It started when we got a letter from United Healthcare that they were switching from Medco Pharmacies (which houses Accredo where we get Connor’s Sabril) to Optum RX pharmacies. All mail order prescriptions should automatically switch over. Of course this raised my cautious red flags. So as soon as the change happened April 1 I called to check the status. After talking to a couple different people, it was established that Optum doesn’t carry Sabril (vigabatrin). I was referred back to Accredo. “So everything stays the same?” I asked. “Yes.” I was told. So today I called Accredo to refill the prescription. First time it picks up to silence. So I hang up and call again. Someone answers this time. They would not fill it as my prescription had been transferred over Optum. “Oooookay. So I call them to fix this?” “Yes.”

I call, listen to more piped music, and give all my personal info twice more to Optum to be told that it’s on Accredo to call and ask that the prescription be sent back, and that they should have offered to do so. Call Accredo again. Again, their line picks up to silence, and I have to hang up and call again. More holding. I tell them that they have to call Optum and get the prescription back. They tell me they can’t because I have no active insurance with them after March 31. They still can’t fill it. “So I call united Healthcare and tell them to do what? What exactly do they need?” I’m told to call UH and ask them to open an active account with Medco so Accredo can fill the prescription.

I call United Healthcare, more holding, more giving all my info, lots more holding, trying to explain, getting transferred, and I end up back on the phone with someone at OptumRX again. NOT what I asked for. He again starts the process of refilling Connor’s Sabril. “But two people told me you don’t have it. You’re saying you can fill it now?”

“I have it right here. I’ll take care of this for you.” I wanted to hope for a second, but deep down I knew where this was going again. “Oh, we have the prescription, but we don’t actually have the med.” Yes. Exactly what I’ve been saying. YOU have the prescription, but can’t fill it because you don’t have the med. Accredo has the med, but doesn’t have the prescription or authorization.

Finally, I do what I should have done all along and call SHARE, who works with the manufacturer to deal with prescriptions. They are now working on getting United Healthcare to give an authorization to one of their participating pharmacies so we can refill his prescription. Obviously who I should have called first, but for the love of God, people aren’t psychic. Those of us outside the medical world don’t understand the inner workings. I don’t fully understand the Lundbeck (manufacturer)/Share/Insurance connection. i just know my kid needs his stupid medication. And nobody offered me any instruction on how to handle this. All I got was a letter from my insurance making it sound like a simple switchover.

I guess I am not meant to understand this world of medical mysteries. I suppose I will never know the following:

1. Why a mail order medication can be so difficult to get your hands on, seemingly more difficult and a kazillion times more expensive now than back when people had to get it from Canada because it wasn’t approved here.

2. How a cranial remolding helmet can appear to be covered, I can be charged our uncovered 20 percent, only for United Healthcare to later deny the claim, forcing time to be wasted on an appeal.

3. Why CHOA employees never return phone calls. (Hey Wanda in medical records, it’s been over a month, but fortunately it turned out I don’t need that paperwork after all, so I guess just don’t worry about it.)

4. Why Obamacare doesn’t attack the heart of the country’s issue, which is that hospitals are charging increasingly outrageous prices with no rhyme or reason, operating off of Chargemasters that aren’t standardized or remotely in line with the actual cost of care, and are allowing this medical crisis a major role in the country’s debt.

Et cetera….et cetera…et cetera…

And to top it off, seizure activity is definitely back. I suspected I was maybe seeing very occasional absence seizures, but then yesterday we saw this. So thank you, hospitals and insurance. All the families dealing with health issues can count on you, that no matter how strong they are, how positively they approach their problems, you will always be there to try to break us.

And I guess now, 2.5 hours after getting up, after writing this blog in a mere fraction of the time I spent on the phone this morning, I will finally have my breakfast.