When the prospect of ‘Buddy’ needing a wheelchair first came up, I was not very receptive. I knew his therapist cared for him and was looking out for him, but it felt like she was giving up in him walking. I took it very hard. I fought it. But then a second therapist said, very kindly, no one was giving up on him. He will most likely walk and maybe even soon, but he will not have the stamina to keep up for a while, and do I really want him straggling at the back of the pack. Wow. No, I did no. I would get the chair.
There was a second reason I was resistant. I had heard horror stories from friends about having to fight insurance companies, sometimes for more than a year, to get a chair even when it was clearly needed. Ugh, here we go.
It was the end of September, and we had met our deductible for the year. If things went quickly, we would not have to pay out of pocket for the chair. I wanted things to go quickly. I talked with a rep from the wheelchair company to set an appointment to fit the chair. I told her that day we were on a timeline, that I expected the insurance company to push back so we would need to be efficient on our side to give us time to fight that battle. The paperwork sat on her desk for two weeks. And so it begins.
I began calling her daily trying to use my Companionate Respect approach. My daily message was; “I know you are very busy. How is ‘Buddy’ case coming? Is there anything I can do to help?” The fire was lit. (She wanted me to leave her alone.) She got her work done and was able to pass me off to the rep who works with the insurance company.
I took the same approach with rep number 2. In our first conversation I told her to let me know if there was anything I could do. I was only too happy to help if the insurance company pushed back. I got a call from her within a day or two. The insurance company said they changed their policy and they no longer pre approve durable goods. They expected me to take possession of the chair, pay for the chair and seek reimbursement ($5-10,000.00). Well that did not sit well. I called the insurance company myself and told my story. I was transferred to Pre-Certification. I told my story again. I was transferred to Medical Pre-Determination. I told my story again. I was transferred to the main line. I started telling my story again. The line went dead and when I called back they were closed for the day. I lost it. I was no longer companionate or respectful. I ranted. I raged. I was glad my son was sleeping.
The next day I repeated the process. This time I asked for managers each time. I was sent around the same circle of transfers. The same circle of frustration. I was relating my story to a friend, and really feeling persecuted and victimized. Luckily my friend stopped me short. She used to work in insurance. She told me I had to stop thinking they were out to get me. The people who work in those jobs do so because they want to help. Unfortunately, they also have a bunch of rules to protect the company from false claims. The next thing she said saved us and got us our wheelchair. She said: “The problem is you are caught in a loop of first tier support, and your case is too complicated for them. You need to request a case manager. They will have more experience and be able to navigate the system faster.” It was as if the heavens opened and a light shone down on her. (This is not the first time she has been our angel, and we are very thankful for her.)
Later that day (end of November) I called and asked for a case manager, and was assigned one. We talked, I told our story one last time and she said she was on it. I believed her, and gave her space. 3 days later I heard from her and the chair had been approved. It would be delivered just before Christmas. We had gotten our chair in 2.5 months! I thought that was incredible timing. I related our story to a friend who was in a similar time crunch. She took our lead, avoided the weeks I spent with entry level people and went straight to a case manager. She got her chair in 2.5 WEEKS!
The best thing about our case manager is that she can open a new case for us any time. It feels so good knowing I can get clear simple answers without having to retell our story a thousand times.
Oh, and ‘Buddy’ loves his wheel chair. He sits up taller. He interacts more with the world. When we are shopping he really looks around the store and reaches out to touch things he passes. Another great thing is that people know before they approach that my son has issues. If that scares them, they stay away. No more awkward moments with people who don’t know what to say, and we have the most wonderful conversations with people who do decide to approach. It is really nice to have people come up and really interact with ‘Buddy’ in a heartfelt way. I am so glad we got the chair, but I still hope we don’t need it for long.
There was a second reason I was resistant. I had heard horror stories from friends about having to fight insurance companies, sometimes for more than a year, to get a chair even when it was clearly needed. Ugh, here we go.
It was the end of September, and we had met our deductible for the year. If things went quickly, we would not have to pay out of pocket for the chair. I wanted things to go quickly. I talked with a rep from the wheelchair company to set an appointment to fit the chair. I told her that day we were on a timeline, that I expected the insurance company to push back so we would need to be efficient on our side to give us time to fight that battle. The paperwork sat on her desk for two weeks. And so it begins.
I began calling her daily trying to use my Companionate Respect approach. My daily message was; “I know you are very busy. How is ‘Buddy’ case coming? Is there anything I can do to help?” The fire was lit. (She wanted me to leave her alone.) She got her work done and was able to pass me off to the rep who works with the insurance company.
I took the same approach with rep number 2. In our first conversation I told her to let me know if there was anything I could do. I was only too happy to help if the insurance company pushed back. I got a call from her within a day or two. The insurance company said they changed their policy and they no longer pre approve durable goods. They expected me to take possession of the chair, pay for the chair and seek reimbursement ($5-10,000.00). Well that did not sit well. I called the insurance company myself and told my story. I was transferred to Pre-Certification. I told my story again. I was transferred to Medical Pre-Determination. I told my story again. I was transferred to the main line. I started telling my story again. The line went dead and when I called back they were closed for the day. I lost it. I was no longer companionate or respectful. I ranted. I raged. I was glad my son was sleeping.
The next day I repeated the process. This time I asked for managers each time. I was sent around the same circle of transfers. The same circle of frustration. I was relating my story to a friend, and really feeling persecuted and victimized. Luckily my friend stopped me short. She used to work in insurance. She told me I had to stop thinking they were out to get me. The people who work in those jobs do so because they want to help. Unfortunately, they also have a bunch of rules to protect the company from false claims. The next thing she said saved us and got us our wheelchair. She said: “The problem is you are caught in a loop of first tier support, and your case is too complicated for them. You need to request a case manager. They will have more experience and be able to navigate the system faster.” It was as if the heavens opened and a light shone down on her. (This is not the first time she has been our angel, and we are very thankful for her.)
Later that day (end of November) I called and asked for a case manager, and was assigned one. We talked, I told our story one last time and she said she was on it. I believed her, and gave her space. 3 days later I heard from her and the chair had been approved. It would be delivered just before Christmas. We had gotten our chair in 2.5 months! I thought that was incredible timing. I related our story to a friend who was in a similar time crunch. She took our lead, avoided the weeks I spent with entry level people and went straight to a case manager. She got her chair in 2.5 WEEKS!
The best thing about our case manager is that she can open a new case for us any time. It feels so good knowing I can get clear simple answers without having to retell our story a thousand times.
Oh, and ‘Buddy’ loves his wheel chair. He sits up taller. He interacts more with the world. When we are shopping he really looks around the store and reaches out to touch things he passes. Another great thing is that people know before they approach that my son has issues. If that scares them, they stay away. No more awkward moments with people who don’t know what to say, and we have the most wonderful conversations with people who do decide to approach. It is really nice to have people come up and really interact with ‘Buddy’ in a heartfelt way. I am so glad we got the chair, but I still hope we don’t need it for long.
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