12/28: Aetna woes

This is a discouraging post, but this a blog... so why not, right?!

I am SO ticked right now at Aetna's continued lunacy. They are NEVER helpful, NEVER give us all the information we need, they stop answering the phones before they are supposed to be closed, and deny nearly everything for Emily simply out of principle. Need I say more?!?!

We tried to start the request to transfer to WI today but the docs just got "no" for an answer. It took me prying and prying into policy to find that our PCP has to make a "non-par request" to be transferred to an out-of-network facility if it is an emergency -- that would have been nice to know UP FRONT -- well, I think it's clear that Aetna has put us in an emergent situation with their original ingeniousness to deny Emily Synagis shots, the vaccination for the horrible virus that has nearly killed her - but they decided to go home early today, so now we can't complete the multi-step process to make a non-par request... until Mon... if they decide to work.

We cannot go to WI now and we can't even get the process rolling till next week b/c of their.... argh... very frustrating!

Emily is doing fine, that's the good part. I would love to have her extubated somewhere where difficult SMA kids are the norm, but we can't go ANYWHERE with Aetna's finger up their noses finding ways to make our lives more difficult than they already are.

It is also my B'day today and we had some friends stop by to take me out to lunch and visit. My parents also came up with my a niece and nephew of mine to visit and have a little party. Thank you guys, you know who are you (point, wink, and click of my mouth) for coming up to visit us on my B'day and thanks for the other phones calls, emails, and other web-based communicated notes that others gave me today. :)

I'm tired now. Hopefully I'll have more positive things to type here tomorrow.


Sky said…
Happy Birthday Nate... Sorry its not being spent under better circumstances. I think the Aetna people need to all be shot, they deny you this and deny you that, if they would of gave Emily the RSV shots she wouldnt be where she is, and all of you wouldnt be facing the challenges you are facing. I believe you can sue them (food for thought) because if I remember they were the ones saying she wasnt at risk (well what do you call this) Sorry Im done ranting. I pray that they will let you guys transfer, so Emily can be in a place where they understand SMA, our kids are not the norm and its about time people start to realize this, they are fragile delicate babies, given to us to love, protect, raise and stand up for. We will keep you guys in our prayers, hang in there, I know you will never stop fighting, and I believe you will win!!! Hugs Sheila
Anonymous said…
Happy Birthday, Nate. As I read your blog about RSV, I am shocked and infuriated about Emily being denied her Synagis shots. It brings back many memories about insurance issues for us as well, but the Synagis shot was not one of them. We had the doctors and Aetna insisting and even requiring Noah get his shots during Maryland's RSV season (Oct.-April). There is even an organization that would call us each month to make sure we scheduled his shots. When we were told about the seriousness of RSV on preemies, we chose to keep Noah out of the public through the RSV season. I thought and was told that it was a requirement for all special needs kids to get these shots. How and why did Emily get denied? Something does not seem right here. Of all kids, Emily should have gotten her shots. When I heard about Emily getting RSV, I was wondering how she got RSV. I assumed she was getting the shots. Anyway, my heart goes out to you as well as our prayers. We care! Focus on Him!!!
Jodia Larsen
Nate said…
hey Jodia - Emily was denied on the basis that she is too old, despite literature showing that SMA kids are HIGLY susceptible to RSV. :( A lot of other SMA kids around the country are hospitalized, have been this year, or will be b/c of RSV and nearly all of them were denied for shots as well!