Nursing Coverage Approved!!

Well, what a few weeks we have had. Due to my regular employer dropping the health insurance that covers Emily's nursing benefits I had to quickly find a new company to work for. That news was nerve racking. Very few insurances available through companies in our area cover Private Duty Nursing (PDN), much less all the other needs of a Spinal Muscular Atrophy (SMA) patient, so the task was daunting -- especially since people aren't necessarily moving between companies very easily these days.

We were very fortunate that a smaller company that contracts in my office wanted to hire me... and digging in their benefits showed us that their insurance provider, Care First (CF), would cover PDN for Emily. So, we started the transition (which is fairly involved as far as my job goes - and 1,000 x's more involved concerning Emily's medical needs). We received EXPERT help from the new company's insurance broker and MANY hours were spent to make sure the transition of Emily's care would work.

So, I started actually working for the the new company this past Monday - only to be told by CF that they would not cover PDN for Emily! Was I shocked? Nope. Unfortunately, I wasn't -- but I was very angry, I'll tell you that! Fortunately, I had spent weeks up until this point communicating with the insurance broker and new employer to create an extensive document trail showing CF that they WILL be covering PDN - we were ready for battle, b/c EVERY insurance company we have ever had to deal with has tried to deny Emily coverage for different medical needs. :/

Anyway, to make a long story short, our nurse case manager with CF presented our case to the Medical Director with documentation of Emily's needs and a Letter of Medical Necessity (LMN) signed by Emily's doctor and they approved to continue the 12 hrs/day that Emily is currently receiving. Yay!

We may still have to find a new nursing agency, but we're trying to work through some political issues to make that work out with our new insurance. For now, Emily has nursing coverage, and that means I can calm down... for now.

Peace <><


Sky said…
Nate that is awesome NEWS!!!
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Nate said…
Thanks Sheila! We're relieved with their decision - and they should be too or... THEY'D FEEL MY WRATH!!! :)

Thanks for stopping by, Cristina! We love followers. ;) I'll do my best to keep up the quality of the posts. :D
Nancy Lee said…
A job well done! What a great set of parents Emily has! And what a great God to answer our prayers! Nate, your diligence and tenacity are awesome!
Anonymous said…
Wow, what an answer to prayer! I'm glad you set the insurance people straight. They obviously didn't know who they were dealing with! :)

Jenny Wilson
Stuttgart, Germany
Anonymous said…
Nate that is so wonderful!! What a nice holiday gift!!!
Anonymous said…
nate, that's awesome news. praise God! that's sad, though, that you have to be that prepared knowing they would try to deny you the resources you guys need...
Mary said…
What great news and relief!! And what a great Christmas present! Give hugs to the girls for me!