Taking on the Dark Side

Well, it's not even 9:00 am, and I've already taken on the "Dark Side," as I like to call our insurance company.  I called this morning about a bill that I received after the entire claim was denied by this managed care company. As I began to question the claim, the representative asked me, "Have you received your explanation of benefits?" Wow. With as calm a tone as I could muster, I conveyed to her that I am actually well-versed in my benefits; I don't need an explanation of my benefits. What I do need is an "explanation of rip off." I mean...really. I offered to explain my benefits to her, which is exactly what I apparently need to do.  This representative then began reviewing the appeal process--a process with which I am already far too familiar. I honestly don't know why I waste my breath talking to these people....which brings me to....

Pregestimil-- Another battle I am preparing to enter with our insurance company. I have developed a game plan, with the help of Elise's liver doctor and dietician. I had the doctor write out a prescription for the Pregestimil formula, and we faxed it-- along with a letter of medical necessity-- to a medical supply company, Apria. Now, I will let Apria fight with the insurance company for coverage of this specialized formula. This formula may well remain one of Elise's many uncovered medical expenses, but it won't be without a fight by this "liver mom," who keeps her social worker cap handy but can quickly transform into "momma bear" when needed.

And now, we get to the "bright side!" I am thrilled to say that I woke up this morning to find that Elise's lab results from yesterday were not a dream!  I just keep staring at these numbers in disbelief. I mean, some of her liver enzymes are still technically elevated, but they are generally trending in the right direction. And as her doctor stated, the conjugated bilirubin level of 0.0 almost cancels everything else out for now. I have to remind myself that her labs could climb right back into the gutter at any time, but at least for now, a liver transplant is not on the horizon.

Sleep tight my little sweetheart...you're doing great!!

(Elise's skin tone is now the same as mine!!)