Financial Crisis is Over

It is now time for the insurance story.

Last night I got a phone call at 6:30 from the appeals manager of Blue Cross and Blue Shield (BCBS). She said that they are going to approve our appeal to be covered at $500,000 for the transplant to be done at Primary Children’s. I cried for an hour as I called Janene and our family to tell them the news. I am crying right now just writing this blog. Those that know me know that I can cry in Star Wars let alone every cry or non crying movie there is.

For those that don’t know the story. Last year BCBS covered us for two million dollars for the transplant to be done at Primary Children’s Medical Center (PCMC). This year the company I work for, NexOne, switched insurance plans inside of BCBS to a different plan. My company and the employee’s were told there was not much of a change between policies. There happened to be a major change with the maximum for transplants. Instead of two million dollars maximum coverage we had a maximum of $250,000 if the transplant was done at PCMC. That $250,000 includes the 90 days after transplant then Lydia’ coverage goes back to her regular out of pocket maximum which is already met for the year. We found this out about two weeks ago. We have been in a panic since. PCMC estimated the transplant to cost about $262,000, plus the last three years of transplant patients at PCMC have used anywhere from $17,000-$105,000 in the post 90 days of coverage. If you do the math, that is a bad deal for us. PCMC has a Medical Aid program that would help cover they said around 75%, but that still leaves a lot of money left over plus the anti rejection meds costing a lot each month the rest of her life.

BCBS has Blue Distinct Centers for Transplants (BDCT) that they cover $500,000 for transplants. The closest BDCT that we could go to for a living donor transplant is Stanford University or The University of Washington. The issue with going to a BDCT is that the post care for the 90 days has to be done at that same BDCT. Every way we looked at that issue we could not see a possible way to have care enough for Janene and Lydia out of state with me having to work and the rest of the family to take care of while still in school. Also, after this current episode at the hospital Dr. Book said that she is not fit to travel.

The reason that we only found this out two weeks ago is that the BCBS policy is new this year and the information was not scanned in to the computer system for transplants for the customer service department to tell either I or case manager at PCMC.

We sent in an appeal last Friday morning. The appeal had a two page letter from us, and a letter from Dr. Book. Because of the hospitalization of Lydia this week we talked to Dr. Book on Wednesday night about the insurance problems and the next day she wanted the phone number of our case manager at BCBS and said that she would not stop talking until she got to the top. Obviously she got to the top.

I know that God works in mysterious ways and uses people without them knowing. This was a miracle. I feel that Lydia’s hospitalization, as fun as it hasn’t been, the prayers of many others, and Lydia’s name in the Temple helped inspire those that could make the difference to act and decide correctly. We thank you all for your fasting, prayers, and help.

Lydia is stable now. Dr. Book is waiting to release her when she can keep her meds down. They took the feeding tube to her stomach out because it was part of the bleeding problems in her esophagus. So far Janene has said that she isn’t taking the meds by mouth good. Hopefully they will figure out what will work soon. I will be taking over the weekend shift tonight.

The good news is that now the transplant will be on April 7th for sure. We are excited to see that the fixing can finally begin. Even though it will be hard on everyone especially Lydia, and Janene, it will finally put us on the road to the best life as possible for Lydia.