Small Setback

Well we finally heard back from the insurance company, and the news is not good. Blue Cross declined approval for Fiona’s surgery on March 7th on the grounds of her being too young for the procedure. We feared this might be an issue.

Recall, the FDA approval for implants is 12 months, but Fiona will only be 10 months old at the time of the surgery. As such, we anticipated this may be a problem, but our doctor has assured us he has safely and successfully implanted many children at 10 months old (as have many other doctors around the world). Early implantation is critical to mainstream language development of children as the infant brain establishes key neural pathways around sound and speech as early as 10 months old. Every month you delay puts the child further behind.

Here’s the exact language of the denial:

No Soup for You

No Soup for You

Still there is hope. BCBS has an expedited appeals process the allows our doctor to speak straight to their medical board. Our doctor has agreed to do this, so we’re crossing our fingers on a breakthrough there.

If this doesn’t work out, it’s not the end of the world. Note the second to last sentence in the response above:

Please note, member meets policy criteria for coverage at age 12 months or older.

So we do want to put things in perspective: she has approval, we’d just have to wait a little longer. As parents we want to give her every advantage as early as possible, provided it is safe to do so. Still, we’re not ready to grab the pitch forks quite yet.

We’ll keep you posted on the appeals process, but for now the March 7th date is off.

Stay tuned for updates…

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7 thoughts on “Small Setback

  1. Phyllis Ellison

    Praying that God goes before Fino’s doctor and the meeting with the committee of BCBS doctors! He can orchestrate a perfect plan for Fiona. Praying strength for her precious parents’ and patience, while they excretely wait for an answer! Love u guys! Aunt Phyllis and Uncle Bob

  2. Amanda Lancaster

    How aggravating… our health care system is just so messed up! Hoping that this is just a minor setback and that regardless of the outcome of the appeals process, things will move forward as they should. Keep you all in my prayers… And thank you for the update!

  3. eewiza

    Thanks guys. :-). It was a pretty discouraging day on Friday. Hopefully we can get better news today. It makes me feel better that Fiona’s doctor can actually have a conversation about this instead of just sending paperwork back and forth. I’m just trying to keep the faith.

  4. Eliza

    Well Fiona’s surgeon called BCBS and they denied his request. On with the next step: an expedited appeal in writing with supporting documentation of the effectiveness of earlier implantation. (And a letter of medical necessity from Fiona’s doctor) Not sure if this will work but we at least have to try. Expedited appeals take 72 hours to review. I’m trying to keep her March 7th surgery date but who knows what will happen.

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