Thursday, March 5, 2009


As previously mentioned, Eli's doctor has recommended (twice now) that we take Eli to a physical therapist. We contacted the physical therapist he recommended and scheduled an evaluation for tomorrow. Well, the physical therapist's office called to say that our insurance company has flagged it as "dummy claim" and won't be covering any services. (I'm not sure who the dummy is here- us or our doctor). Lucky for me, I saved the following letter that Margo wrote to her insurance company so that I could one day use it myself (slightly adapted for our situation):

"Dear Losers:

You guys suck. And you suck hard. This letter is to inform you of your complete suckage. Please accept this as part of my documentation for my LEVEL 2 appeal in the decision to deny coverage for services for my son.

Apparently, my first letter and the letter from the pediatrician was not enough information for you. While I understand that everyone at your organization is smarter than the doctors who request the work done, please don’t let that get in the way of denying my second attempt to plea for coverage.

If I thought for one second your ignorance regarding the changing world view of family building would be enlightened, I would take the time to report to you why it DOES MAKE A DIFFERENCE that my child is from Ethiopia. You say on the phone that you will treat my child like any other child when it comes to reviewing what is routine or not routine work. I assume you mean you will treat my child like a child born in America, in a hospital with doctors and nurses, to a woman who probably took pre-natal vitamins and had routine check-ups during her pregnancy. Who then went home to live in a clean, semi-sterile environment and had well baby visits at birth and then monthly until 6 months.

My child is unique in the fact that very little is known about his early months. It is possible that he was born in a small hut on the dirt floor with no doctors or nurses around. It is possible that he was then exposed to a myriad of diseases that are common right now in Africa. We have no way of knowing the medical situation of his birth mother or family. Even after being delivered to his orphanage where I praise God for the women that took such loving care of him, it is still possible that he didn’t receive the best medical care.

So it is upsetting to me that you would deny coverage for something that his pediatrician thought was medically necessary to ensure his continued good health. More upsetting is the fact that you haven’t made changes in your policies to account for the rapidly growing number of international families being made through the miracle of international adoption.

So, until you do that, I’ll continue to tell the physicians that you (evil doers) have their money and give them your number."


Jaime said...

this totally sucks, nikki! have you checked with the Little Red school house (lynnwood) or Wonderland (Shoreline)? if you have an Early steps (or whatever it is called in WA), it is free (i think) if he is delayed "enough". Also, ask Jeanette for Nikki Savage's info...Nikki is former Journey member who was an Early Intervention speech guru...she is my Yoda on everything therepy!

Rob & Candy said...

Boo is right! I hope the insurance company gets it right and Eli is evaluated soon!!

Ferrah said...

This made me so mad when this happened to Margo but for it to happen again that is ridiculous!!! You should send that letter with pictures of Eli! How could they say no to such a precious little boy.


Kristy said...

Do yall have First Steps? It is the govt program for early intervention before age 3. Ethan recieved free Behave. Therapy and Speech Therapy through them. Then at age 3 the local school system usually takes over and begins their early intervention program. I am not sure how it works there but it's worth a try. I hope he gets what he needs! It stinks to have to go round and round with the ins companies!

Roscoe and Julia Richardson said...

Keep badgering them - I was denied care with soo much documentation (labs and letters) as a kiddo and even now as adult - it's standard practice to deny care at least in my experience - they just bet you won't call and bug em about it (seriously!). Keep calling - with documentation of medical necessity and a referral letter to the PT, they have to cover it and they know it - they'd lose this one in court. Yes they SUCK - lol! said...

Love the letter, but sorry about your head aches...I'm sure we'll a few of our own in the not-so-distant future...
Alisa :)