Back in March I posted about Gavin’s win against our insurance company in the battle for his adaptive stander. I am still in shock that it took us a year, numerous internal appeals and an external appeal to get it approved. But it also left me feeling worried and nervous if that would happen for every single device we would need for him moving forward. While at Shriners in April we had Gavin fitted for a new gait trainer (AKA walker) and I fully expected to have to go through the same year-long battle. But this time things would be different. I would be ready for that battle. I had “people” now.
In my excitement over the fact that we had actually won our external appeal, I only gave a brief nod to the organization that was the driving force behind our monumental (at least to us) win – The Office of Healthcare Advocate (AKA my “people”). Simply put these folks are AMAZING! I cannot say enough about how responsive, helpful, supportive, informative and understanding our advocate, Caroline was. Not to mention EXTREMELY patient with me! In my opinion, Gavin wouldn’t have his stander if it weren’t for all the hard work and effort put in by Caroline.
From the get go, Caroline told me it would be a process – but she was there every step of the way. She asked me a bunch of questions and we got all the paperwork filled out (including an official application plus a $25 application fee – which we got back since we won) and I sent her any/all letters of support from Gavin’s team. From there she worked her magic. She checked in often and let me know how things were going, where in the process we were or if she needed additional information from us. And then, one day she called with the BEST NEWS EVER: we had WON!
I HIGHLY recommend that if you have questions on health insurance or a denied claim to call these folks immediately (http://ct.gov/oha/site/default.asp). They are an independent agency here to help CT residents navigate the very murky and confusing waters of health insurance. And just to be clear – it doesn’t matter where your insurance benefits originate from (employer or state exchange) they will help if you have a question/problem.
Of course because I was ready for a battle, or because as Gavin’s PT jokes, the insurance company just doesn’t want to deal with me anymore, I didn’t need to call MY advocate. After what I can only assume was a review process by someone with common sense (and much to my delight) our insurance company approved Gavin’s walker – no appeals, no requests for more information, just an approval. We actually picked it up last week and will be sending it off to daycare for him to chase the girls around… um, I mean for him to play with his friends.
And to Caroline and OHA – Thank you so much! Without you Gavin wouldn’t be continuing to develop and grow and stay healthy.