Insurance frustrations and resolutions, and Halloween

Friday started out to be a good enough day. I went to work, as Ricky was excited to go to school (after being out for 3.5 days) because he had a ceramics project coming out of the kiln.

I'd been trying (along with the pharmacist at our local Walgreens) for over a week to get Ricky's Pulmozyme paid for. First Medi-Cal was saying they would pay for it only if CCS denied it. Then CCS informed me that Ricky's Medi-Cal was canceled as of October 18. I called that good supervisor at the county and she confirmed to me that it was NOT canceled but given a different code. I called CCS back and they said they would have to check on it. On Friday they finally did and then I couldn't get a straight answer from any of the people I talked to over there. For one thing, they were concerned that Ricky would have a gap in coverage Saturday and Sunday before Healthy Families kicks in. I have to admit that I was concerned about that as well.

The nurse at CCS told me that she would make a decision about coverage if I had someone fax the prescription over. I frantically called the CF clinic to ask if they would fax the prescription to CCS and also send it to the outpatient pharmacy at Stanford, since at this point it was too late to have the med ordered (it's a special one that costs a lot of money) by any ordinary pharmacy. The best person I dealt with today was the patient care coordinator at our clinic, Miguel. He got that whole thing done in under an hour. I am going to call his supervisor and praise him up and down. He is AWESOME.

So. The situation when I left work was this: The prescription MIGHT be covered if they got it faxed to them before 2:30 (at this point it was 1 and I had not heard from Miguel yet). And they needed me to come in for an income eligibility interview in order for Ricky to at least be covered by CCS over the weekend, in lieu of any other health coverage. (I called Healthy Families and asked them to extend his Medi-Cal for two days and they said it was against their policy. I said, "So the state of California wants my ill son to be without health coverage for two days?" and basically heard "yes". I asked for a supervisor to call me and was told that someone would call within one business day. Great, how helpful. No one ever did call.)

Oh, and in the middle of this, I got a call from the teacher's aide at Ricky's school that he had laid down during ceramics class (his favorite class) and was feeling hot and sick again, and could I come pick him up? Perfect.

On my way to get Misty from day care after work, I called the nurse (our case worker) at CCS about the prescription and got into a shouting match with her. Basically the same beauracratic (sp?) stuff. She ended up hanging up on me because I grew so frustrated and angry with her.

You know what finally angered me so much about this nurse? She kept saying "you shouldn't wait until the last minute to get your son's medication." EXCUSE ME? I ordered it over a week ago. It was not MY fault that they couldn't freaking work it out with the pharmacy. She even had the gall to say that the pharmacy had never contacted CCS, when I knew they had. Grrr.

At this point I decided that I was not in the right state of mind to go pick Misty up, so I called Liz the babysitter, and she said don't worry about it, and Misty could stay there as long as she needed to. Liz is ever-patient and always says how she doesn't know how I do it all (I don't either). So I proceeded toward Ricky's school, and then got a call from them that he had had lunch and was doing okay now. Whew.

So then I went home and printed out my last three pay stubs to take over to CCS to prove the eligibility. When I got there, I asked for the supervisor and went into a meeting room with the eligibility worker and the supervisor and we got all of the documentation laid out. The nurse, even though I had shouted at her earlier, had approved Ricky's medication (because Miguel from the CF clinic had faxed it over) and I could go up to the hospital outpatient pharmacy to pick it up. *sigh of relief* We had CCS coverage over the weekend. We have CCS coverage secondary to Healthy Families until next August. I signed all of the papers and thanked them both profusely and then I was on my way.

I picked Misty up from day care, calling my mom along the way to give her an update. Then Misty and I went to LPCH and got the medication. I had been given a print-out from CCS with the authorization information, and that turned out to be useful because the outpatient pharmacy had not been able to pull it up in the computer. We got the medication with no problem and no money needed and I practically did a dance and hugged the pharmacy tech. Well, I didn't really hug him but I felt like it. Then Misty and I headed home to get the costume stuff and other Halloween stuff and proceeded to my mom's.

I had grabbed Ricky's portable compressor, so when I got to my mom's the boys, who had already had McDonald's for dinner, we watched TV while Ricky did his treatments (including the Pulmozyme, yay). Then they and Misty got into their costumes. We trick or treated at about five houses on my mom's block, drove to a few other friends' houses to visit and trick or treat, and then went to the fall festival at a local church. That turned out to be a big hit. The boys played lots of games over and over again for candy, and bounced in giant bouncy houses. Misty played a few games and bounced in the little kid bouncy house. She got a TON of comments on her cute rooster costume. By the end of the night (9:00) she was falling asleep on me. I changed her into her pajamas before we left there and she went right to bed when we got home. The boys' candy containers were totally overflowing!

And finally, here is a picture of the kids in their costumes.