Aurora Borealis

I don’t think insurance companies should be demonized the way the Democrats have been doing; but they indeed have their problems and can be very annoying and short-sighted.

Agent Murphy had his regular speech therapy on Monday.  After we got home, the CHOA location we go to contacted us to tell us they had just been informed by Aetna that all the visits since the beginning of February are being denied.  Mind you, the therapy site contacted Aetna sometime in December to re-verify benefits for 2010 and were told everything is fine and we’re covered for 60 visits per calendar year.  He’s had maybe 13 so far in 2010.  And all the appointments in January processed normally.  By the time I spoke with the insurance specialist, Candy, at the therapy office, she told me our therapist was already going to war pulling together information on medical necessity.  She was drafting a letting about it which she was going to get over to our pediatrician’s office so they can sign off on it too.

Candy asked me to call Aetna to find out what I could from my end while they start the appeal process.  I spoke with Lisa C. at Aetna, who informed me that after some number of visits billed under the same treatment code, they want additional information to find out if the treatment will bring the patient to a “restorative state” before they continue to pay.  She said I was in a good position if the provider was going to go to bat on the Agent’s behalf, because they’ll have all the medical documentation Aetna is looking for.  Her sense was that when they have the documentation they’ll go back and pick up all the denied claims and reevaluate them.

Well, okay, wanting to know if a course of treatment is effective rather than futile makes sense.  But is denying coverage to force an appeal the only way we can accomplish that?  How about a simple request to provide certain medical documentation by a certain date, after which treatment won’t be covered until the documentation is provided?  No, no.  We can’t do anything so reasonable.  Just deny the claims.  And interrupt the treatment.  (Unfortunately, Candy was out sick today so I couldn’t talk to her about whether we should keep proceeding with his visits normally or suspend them until this is resolved; so the person I did speak with suggested that it was best to be safe and cancel tomorrow’s appointment and then get better guidance from Candy when she’s back.  Fact is, if they’re going to end up denying coverage in spite of the documentation, we can’t afford to be on the hook for more than we already are; even on the covered visits, we’ve still paid a pretty penny.)  Of course, we’ve just started gaining some momentum since introducing the communications book and device.  And I hope this interruption doesn’t mess that up.  Fabulous, right?  We’re not sure if this treatment is effective enough, so we’re going to interrupt it and make it less effective.  Stupid, stupid, stupid.

Anyway, we did get our communications book from Miss Lindsay on Monday and we need to start using that at home.  (We need to make braille labels on it for Daddy, too.)  The plan is to primarily use the book at home and the device (the loaner) in therapy.  Yesterday Agent Murphy did really well using the device.  And he’s even trying to say the word himself when he pushes the appropriate picture.  Miss Lindsay’s theory is that with the device as back up, he’s less frustrated about not being able to make all the sounds so he’s more willing to try them.

Long time no post!  We had a nice trip to Chicago at the end of May.  Agent Murphy was a real trooper in the car, even though we got stuck in construction traffic on the first day coming back (on Sunday!) so our planned leisurely half-trip ended up with our getting to our hotel in Kentucky very late.

We went to Lincoln Park Zoo and had hoped to make it to the Children’s Museum, but Mr. Tldz and I were both a bit under the weather.  On our penultimate day there, my mom hosted a get-together of family of friends, and it was good to see lots of folks.  And Agent Murphy receieved several gifts, for which thank you notes are forthcoming.  Saw my sister and her family briefly Sunday morning at Mass.  Unfortunately, we ended on a bad note with my mom, but hopefully little by little we will rebuild things.

Agent Murphy had his hearing screening shortly after we returned, and as we expected, all is normal there.  Last week he had his speech evaluation, and the therapist is leaning toward the idea that he has a lazy tongue.  So we’ll start weekly speech therapy in a few weeks when we hear back about scheduling. Her sense is there’s no reason to think he won’t respond to therapy, that just a little boost should be enough to get him started talking.  We’d sure like that!  So now I have a bunch of handouts to read through with ideas to try to stimulate language, and we’ll work on that while we wait for therapy.

We had a big day yesterday.  Agent Murphy and I finally made it to play group at church for the first time in a long time.  He’s still pretty reserved there.  Then we went to Mobile Mother Goose at the library in what we hope will be our new neighborhood.  (Of course, I couldn’t resist driving by “our” house.)  He wasn’t sure what to make of all that.  We’ll try it again next week.

Speaking of “our” house…  The price has been reduced again.  It’s making me really antsy that someone will snatch it up before us.  We’ve had a lowball offer on our house.  We’ve countered and are waiting for the response.  And we’ve had a couple more showings.  But we’re on the verge of changing realtors if this current flurry of activity doesn’t yield anything this week.  We met with a guy on Saturday who has ideas about actively marketing our house, rather than the “let’s list it and wait and see who shows up” approach our current agent takes.

Had RW and S. over for dinner Saturday a week ago to thank them for keeping an eye on the house while we were away.  It’s always fun to catch up with them and we rather enjoy the challenge of finding onion-less recipes to serve to S., since most of our recipes start “chop 1 onion” (or more).  Ah, but the pork tenderloin with poached plums that we like has no onions. Yum!  We look forward to getting together with them again around mid-July.

Mr. Tldz and I both had physicals last week with our new primary care doc.  We need to schedule our blueberry picking outing, and a day trip to the dairy north of here.  And I need to carve out some quality time to spend in the basement getting organized down there so we can be ready for the move when the time comes.  Other than that, it’s the same old same old around here.

Mr. Tldz and I read more of Miss Betsy: A Memoir of Marriage last night, and then again this morning, as we decided to be a little bit lazy.  We had breakfast.  I went to the grocery store.  (Normally a Friday night task, but yesterday’s normal schedule, as you know, was interrupted.  On that note…  My lips aren’t really tingling.  I’ve been using a lot of lip gloss, because I think what I’m feeling now is the burning/stinging of chapped lips.  I suspect yesterday when they were a little bit numb, I kept biting or licking at them to make sure they were still there.  Shoulder is sore, but very bearable.  Pain killers a couple of times a day it seems will suffice.)  We unloaded groceries, had lunch, put Agent Murphy down for his nap, I did a little cleaning around the house.

I headed out to check our local children’s consignment store.  I got Agent Murphy a number of spring/summer items there last weekend, but the stuff for boys is always pretty slim pickings.  They said they were getting more stuff ready to put out, so I thought I’d check back today.  Hooray – several more cute items, including one I’d meant to pick up last week that we’ll hopefully be able to use for 18-month portraits.

Since I’ve returned, I’ve made most of the meal we’re delivering tomorrow to church friends who recently had a little girl.  Mr. Tldz has dessert for them (blueberry cobbler) in the oven and is working on a blueberry pie for us.  (Time to finish off our blueberries from last summer before blueberry season rolls around again.  July will be here before we know it!)

Agent Murphy is awake now, so I must go tend to him and help Mr. Tldz in the kitchen.  And there is much more cleaning to do tonight and in the morning, as our realtor is holding another open house tomorrow afternoon.

Because I had absolutely nothing to do today, I spent a few hours in the ER at St. Joseph’s.  It all seems a little silly now, but…

I had some sudden onset pain around my right shoulder blade this morning.  I thought maybe I’d slept funny.  Then it moved around to hurting also in the upper right part of my chest and under my arm – muscular type pain.  And I was just feeling not quite right – a little flushed or something – just not quite right.  And then a while later my lips started tingling.  That pretty much pushed me over the edge.  I called our friend R. to see if he might be available to watch Agent Murphy if I had to go to the doctor or something.  He had his wife, C. call me to hear about my symptoms.  (She’s a pharmacist by training, so she has some medical background.)  She decided St. Joseph’s would be the best place to go.  She came over and watched Agent Murphy while R. took me to the hospital.

So I had bloodwork, IV painkiller, an EKG, and chest x-rays.  Everything came back normal, so they’re treating it as some sort of skeletal-muscular injury and prescribed pain medications.  They don’t know why my lips are tingling, but say that’s a classic symptom of hyperventilating. so it may be that because of the pain I’m breathing rather shallowly and not exchanging oxygen and carbon dioxide normally.  I sure don’t feel like I’m breathing abnormally, but whatever.  My lips aren’t back to normal, but they are a little less tingly now.  The IV pain medication worked so well, that initially I thought I wouldn’t need the prescriptions.  Yeah.  On the way home I changed my mind and filled both prescriptions.  Mostly I just feel it in my shoulder now.  All very strange.  And rather scary.  I’m glad it wasn’t anything serious, like some sort of cardiac incident.  And I’m glad we have such good friends who will step up for something like this.

Mr. Tldz was able to relieve C. of Agent Murphy duty a little before 2:00 because his new boss offered to drive him home, so he didn’t have to wait until 3:00 to catch the first bus.

I’m glad to be home with my family!