Tuesday, December 30, 2014

Fighting the insurance company

Yes two months later and we are STILL fighting the insurance company for Lilah's rsv shot. Progress is slowly being made, but it is progress. I won't lie, I am furious! But, I also know that being furious with these people won't move us any closer to getting these shots for her. Therefore, Al is taking care of this situation and filling me in when he gets anything new. Well today we did receive some more news. Here is a breakdown of what has been going on:

We were first denied when Lilah was released from the NICU back in November. She did get her first shot while in the hospital. We contacted the insurance company to find out why she was denied. Come to find out, our pedi didn't give them the required information, only that she was born at 30 weeks. So our Cardiologist wrote a letter of medical necessity stating that Lilah had congestive heart failure and could die if exposed to RSV. We then get the run around for weeks and weeks. Between Al and the Cardiologist calling almost daily, we were finally put through to a case worker that has been working with us. Another two weeks go by. Now Lilah is two weeks past her second shot (which she never got). Today Al gets a call from the insurance case worker asking if we got the shot approved. He told her that we STILL haven't heard back. So of course she puts us through to a woman that handles all of the HCA insurance ( company that AL works for) who then tell AL that Lilah should have been approved for all the shots because employees of HCA don't ever required pre-approval. Are you effing kidding me??  So Lilah is now going 2 1/2 months of no RSV shot and is now at home sick with a cold and she should have been able to get the shot all along??? I think it is safe to assume that I am beyond furious at this point. Al is still waiting on another call back and we will see where to go from there. I firmly believe we have been getting the run around this long because they are prolonging spending the money on these shots, until they absolutely have to. 

So we wait some more.........................

Like I said, me and the two girls are all sick and at home with coughs, runny noses and feeling like crap. I am a complete paranoid mess about Lilah getting sick. I have been bleaching the house, bottles, pacifiers, my hands, everything. I am also wearing a mask and running the humidifer. We are doing steam treatments in the bathroom twice a day. Poor Olivia's nose is starting to bleed from either all the sucking or the cold. I was hoping the saline drops would help that, but they don't seem to be helping that much.

Keep us in your thoughts for a speedy recovery.

I will update when we find out what is going on with the RSV coverage.


  1. I am pissed too! What a bunch of BS! Someone needs to hold these effers accountable! I just hope she gets this shot ASAP. Feel better Rapp's!!

  2. oh the insurance companys :( It should be a crime that your baby hasn't gotten this shot yet!

  3. Since HCA has given you this information, is there legal action you guys can take against your insurance company? They are putting Lilah's life in danger and you may have a case against them.

    I'm so sorry Toni. My vote is screw the insurance company and get the shots. Bill them directly and line up a lawyer. You have more than enough evidence. And the CEO should swing for this.

  4. Ugh, I hate dealing with insurance. I'm sorry this is so frustrating. I don't know if this is any help at all, but I get really bad nosebleeds too when I get colds and dry weather. Can you try putting a little vaseline on a q-tip and putting it just inside Olivia's nose? It's not much, but it seems to help my nose and the capillaries from drying out and cracking so much, and may give her a little relief from the nosebleeds. My doctor suggested this for me when I was a kid and got them really bad at night when I was sleeping. Good luck and thinking of you!