Eliza Grace was born on March 15, 2006, at 26 weeks, 4 days, weighing 1 pound 4 ounces and measuring just 11.5 inches long. She is the light of my soul and this is the story of our life in the big city.

Thursday, March 11, 2010

Just When I Thought It Was Safe....

.... this man



or one of his fawning minions decides once again not to pay for Eliza's formula. Who is this concerned looked gentleman? Why none other than Stephen Hemsley, CEO of UnitedHealth Group, parent to UnitedHealth Care and Oxford.

Really I thought I would make it at least through the first quarter of 2010 without having to rant and rave about the deplorable state of health insurance in America. Since there are TWO refills left on Eliza's formula prescription (which would cover another 2 months) I really figured that this would be a dead topic till well past Easter. But no. I tried to refill Eliza's formula with the truly lovely people at www.cvs.com and they tell me the claim was rejected because: "UnitedHealth Care Oxford won't pay for anymore formula." Even the pharmacist at CVS thought this was a pretty suspect reason, especially since UnitedHealth Care Oxford had already precertified two more months of formula.

Of course by the time I hear all this the customer service people had long gone home, so the battle will begin anew tomorrow.

In case anyone is wondering, Mr. Hemsley (a Fordham University alum, class of '74) could probably pay for his own kid's medically necessary formula since his 2009 compensation was about $3.2 million with a 401(k) Plan of about $10.7 million. Probably wouldn't notice a few thousand missing shekels.

10 comments:

Mel H. said...

That is SO disheartening. When I tried to fill an Rx for Elecare, the first thing CVS said was that Oxford wouldn't cover it and it would be $50 per can. Is it just me, or is that obscene???

Anne, Eliza Grace's mom said...

These people are evil incarnate.

Under my policy formula is a pharmacy not a medical benefit, which is why I would get it online from cvs.com since they have home delivery of the stuff (I was not keen on carrying 72 pounds of formula from the local CVS). In order to initially get the formula covered I needed paperwork from Eliza's:

Pediatrician
GI
Endocrinologist
Speech Therapist
Feeding Therapist

They denied it F-O-R-E-V-E-R claiming that surely Eliza would eat a freaking steak if it was just prepared right. I even some total witch say to me "well I see we have already paid over $2.3 million in benefits." I have no lifetime cap and told her too bad sister, your company lost this bet big time and oh, by the way, I will NEVER change insurance companies so get ready to write another #2.3 million in checks.

Evil and Nasty.

Anne, Eliza Grace's mom said...
This comment has been removed by the author.
Anne, Eliza Grace's mom said...

Here is the latest conversation with UHC Oxford:

Oxford: "The reason your claim was denied is because your plan administrator changed the terms of your coverage."

Me: "I am the plan administrator and I can assure you I have not changed our coverage."

Oxford: "Well there is nothing we can do. You need to address this with your plan administrator."

Me: "But I am the plan administrator."

Oxford: "You really need to speak to your plan administrator."

Me: "OK. I have just had the discussion in the bubble over my head and I can assure you the plan administrator has not changed our coverage so as to starve her own child to death."

Oxford: "Perhaps you should speak with a supervisor in Group Administration, let me transfer you."

Sarah said...

Oh Anne, I hope that it all works out. I am getting nervous that this might be how we end up, but I am thinking since we have a g-tube it might be easier. Sorry it has been so rough!

I haven't seen you 'round the blog lately so I thought I would check in and make sure you are doing well!

Natalie and Abigail said...

Good grief. Anne, are you sure you didn't change your plan so your kid would starve????

Gotta love your recap though...Give'em hell Anne.

Sara said...

The REAL question is: Will they buy the 12 sprinkles she'll eat for dessert after her well-cooked steak?? (Just trying to make you smile. Sorry this is happening. We love you.)

xoxo
Sara and Mags

Anne, Eliza Grace's mom said...

I think you have hit upon the real problem Sara, I have not been adding sprinkles to Eliza's steak. Perhaps if I marinate the steak in sprinkles instead of A-1, she would have a go at it!

knitnkanmani said...

You are an wonderful mother .So many times I have come here to recharge , because my daughter ..too was born at the same gestattional week..but I was high risk pregnancy too many complications ..

Kathleen said...

I just had the receptionist at WIC attack me over my newborn's medically necessary formula. He wasn't that premature (36 weeks) but he is low birth weight due to in utero stress from pre-eclampsia and my breast milk supply wasn't coming in fast enough so my doctor wrote the medically necessary formula form. But the receptionist at WIC gave me a lecture on "why aren't you breastfeeding? you shouldn't need this formula. Try harder and see a lactation consultant because you must be doing something wrong." Fortunately the counselor in charge of writing the WIC checks for the formula was much nicer but still I am amazed that a doctor form saying that a formula is medically necessary means so little.