The Appointment That Wasn't

We drove all the way up to the contact lens specialist's office today, an hour drive. Only to be told that insurance is denying coverage.
We waited there while they talked to the insurance company, and I made calls to them, as well. They said they needed more information. The lens specialist gave them the same info, billing codes and diagnosis codes. They said it was in processing.
I was told by the insurance company that I should use an in network provider, yet they did not have one to recommend. They told me to ask our ped. ophth, well, we did and this is who he refers his patients to. I was told I needed to talk to our primary provider to have them do an out of network referral. Well, we did. We did everything we were supposed to do, the doctors did everything they were supposed to do, yet the insurance was still denying coverage of this medically necessary contact lens and fitting.
The specialists office told me I could pay for it myself, but insurance would not reimburse me. When I asked what I was supposed to do, since I could not afford the bill, she told me, "parents are expected to provide for their children". That was very hurtful and uncalled for. We so provide for our children. My husband works very hard to do so. We also have insurance that is part of that provision, and we expect them to do what they get paid for.
If there were somewhere else to take Josh, at this point, I would. I do not like to give people like that my business.
On my drive home, the specialists office called to tell me the insurance approved the lens, but not the visit. She told me I could come back and have the lens fitted and just pay the office visit, which is $125. Or, I could appeal the decision.

When I got home, I called the insurance, they said the reason the office visit was denied was because it had not been requested.(?!) What a big mess. It was requested, in the out of network referral request by our primary doctor!

Now we wait for the insurance company to talk to the lens specialist's office to negotiate what the least amount they can get away with paying.
Josh's appt was postponed til Dec. 1st, unless they have a cancellation.

I have been fighting, begging, pleading, petitioning, going to state representatives, you name it, for the past almost 6 years on behalf of Josh. I am weary of it, so I am sitting in my house crying this afternoon. I cannot understand why things have to be so hard for my little boy. After Thanksgiving, I will rally my strength and begin the fight again, but for now, I just need a break.

Lens Appointment Tomorrow

The ped. ophth. called me Monday afternoon. He spoke with the contact lens specialist and they are making arrangements with the insurance companies for out of network care for Josh. So, hopefully, the insurance will cover a good portion of the bills for the new lens.
The next big hurdle was they were not able to see Josh until next Monday. They promised to call me if they had a cancellation and could see him sooner. I posted a prayer request to our church, as I was also praying for an opening. Not more than an hour went by and they called to say they had an opening! Praise God!
Josh will be going tomorrow at 9:45am to see the lens specialist! I am eager, yet apprehensive about the appt. I think many parents who have children with special medical needs can relate to feeling apprehensive when it comes to change. Even if the change will be positive, and I hope this is positive, it is still hard to adjust.
Josh told me today that his left eye was very tired. His left eye is his healthy one. I told him it makes sense that it is tired, since it is having to work harder since his right eye is not doing any work right now, without a contact lens.

I have not required any school work from Josh during this ordeal, but he continues to get his school books and work anyway. He is learning to read, and is eager to continue. He loves to draw, color and cut. Today, he drew little pilgrim boys, colored them and cut them out, to decorate our kitchen walls.

The challenging thing might be getting Josh in the door at the lens specialist's office. He told me he does not need another doctor, Dr. M takes good care of him, and he does not want to see anyone else. When I explained to him that Dr. M wants him to see this other doctor, he said, "No, I don't think so".

Ordained Days

We had an appt for Josh to see the contact lens specialist tomorrow. But needed to reschedule for the following Monday. We are hoping to make some sort of arrangements for insurance to cover the care. They sent paperwork that said we would owe anywhere from $130- $800, and this does not include the office visit. It is only for the specialty lens.

I made a number of phone calls and tracked down another lens specialist. This one takes insurance, but not for patients who have a medical diagnosis, they bill for vision only.

So, we continue to wait to see what will happen after our ped. ophth. talks to the other specialist tomorrow. It is very frustrating, since Josh is walking around with 20/800 vision without his contact lens. He is still young enough that amblyiopia will get ahead of us and he will lose the vision he has worked for.

It is hard for me to keep in mind that God has all this under control. He has this all figured out for Josh. I am again reminded of a verse that someone directed me to shortly after Josh was born: Psalm 139:16 All the days ordained for me were written in your book before one of them came to be.

One of Those Days

Well, it actually started last night with a phone call from my 19yo daughter. Her car had overheated really bad while she was waiting for the cop to write her speeding ticket. She was at a friend's house and they were bringing her home and letting the car there.

I had an appointment to take Christopher for his post-up exam at the ENT, which is close to my daughter's school. I left early so she could get her equipment from her car and dropped her at beauty school.

It occurred to my husband and I lately that this daughter seems to assume we will take care of things for her, and then does not express any appreciation. This weighed heavy on my heart all day today. We decided she needed to help with fixing her car, even if that meant helping her dad get parts from the junkyard.

Most of the way home, I felt like I was getting the cold shoulder from her this evening. Then she finally admitted that when her dad talks about what her car needs she really does not understand, and she does not mean to appear indifferent or like she has a poor attitude. I explained to her how she could easily explain that, and have a bit more humble presentation and it would go a long way.
When she began talking to her dad, he felt she should try to understand how a car works. I pointed out how his eyes glaze over and he appears disinterested when I try to explain our children's medical issues to him. Ahhh, now he understands.


Allura's car needs new heads, whatever that means. She stopped at the bank for money for the parts and they went to bring the car home this evening. But dad is no longer trying to tell her how the car works, except that she needs to not push the gas pedal down to the floor quite so far(!).

Josh got a brand new lens on Wednesday. It was in his eye 24hrs and caused irritation. So, another call to the pediatric ophthalmologist. He now feels it could be the fit of the lens. Josh will need to go to a contact lens specialist, to be custom fitted. Silly me, I thought that was what eye doctors did!
The big problem with this is the contact lens specialist does not accept insurance. So we will need to pay up front and try to get reimbursed from insurance.
We do not really have a choice since Josh cannot see with his right eye without a contact lens.
Did I mention it was one of those days?

On a brighter note, I am seeing improvement in the participation with chores. I came home today to my daughters making a new chore chart. They were working it out and it was looking do-able.

Being Firm Can be Tough

With all the extra doctor appointments lately I have been lax on enforcing the rules of our house. This has led to some chaos, and we are all having to pay the price.
We have a routine and we have a chore chart. Everyone knows what is required of them, whether Mom is standing over them or not. Lately, the chores have been done without enthusiasm and haphazardly. This does not work in a large family. We have also encountered bickering about chores. Yikes!

So, I have had to make some new rules and become firm when enforcing them.

I told my older children it was fine if they did not want to do their chores. I am not going to remind them, and I'm not going to tolerate bickering. If they don't get to them quickly, it's ok, too. (It isn't really, I'm teaching them something with all of this.)
I will quietly do their chores for them, and once I begin, they are not allowed to take over. Sounds too good to be true, doesn't it?! Well, here's the catch. If I have to do their chores, they get to stay home. This week, it meant no homeschool group activities.
I know to many it does not sound fair that the entire family missed out on a fun day with other homeschool families. But this teaches my older children that what we do affects others. The choices we make cause others to suffer, not just ourselves.

This is causing me to suffer, in that I am doing much more of the work by myself. But I am also not taking one of the older children along to help me with the younger one's appointments this week. This means getting two little ones in and out of the carseats alone, and managing a stroller and a toddler at appointments. (Something I did when I only had two children, but it was easier back then, when I was younger.)
Why not just take a helper? Well, the one who is my usual helper feels privileged to go along, since my helper usually gets a treat from McDonald's. We usually run errands while we are out, and this often means a stop to the craft store. It also means time away from the constant activity of the house.

This is not a permanent situation. This is to get their attention. Today is Wednesday, our third day of implementing all of this. I already see signs that it will not need to be longterm. I see children going quickly and quietly to their work. I am hearing less arguing.
I will re-evaluate on Monday. If the attitudes are changing, the privileges will be re-instated.

All of this is very hard for me. I enjoy having my children go places with me, and I enjoy taking them to homeschool group, and doing things with them. I tend to feel guilty because I need the older children to help out more since the two boys were born with health problems,etc. I am really having a hard time being tough. But I know it is for their good. If there were no consequences for their actions, they would never learn.
You see, it is not so much about whether they help keep our house neat and tidy. It is about their hearts. If they do not have diligence in their hearts now, and have healthy work habits, it will affect their future. Who wants to hire someone who won't do their work, or does it carelessly? Who wants to marry someone who is contentious?
I will be relieved when my life in the shoe is back to functioning peacefully again.

Another Trip to the Eye Doctor

Josh developed eye redness again Wednesday morning. He got up crying in pain, his eye very red, and very sensitive to light.
His pediatric ophthalmologist asked us to bring him in on Thursday. By then, of course, the eye was not as red, since we took his contact lens out right away. He was also back on the abx drops. But it was still red.

The ped. ophth. said he needs a new contact lens, and not to put the old one back in his eye. We have one ordered, but it can take up to 2 weeks, depending on the mood of the insurance company. Funny thing, sometimes, the insurance company will tell us they only cover contact lenses if they are medically neccesary, and will deny Josh's lens. Then I have to do battle with them. Do they really think I would put a contact lens in my 5 1/2yo son's eye if it were not medically neccesary? Do they think we would have started this at the age of 6wks just because we did not like how he looked in glasses?! (He looks very cute in his glasses, by the way, but they do not take the place of his contact lens, they only help the contact lens, not replace.) We can go along for a while, with insurance paying for the lens, then suddenly, with no rhyme or reason, they give us problems and refuse to pay. So far, I have always managed to get them to pay. But there have been times I have had to write very strongly worded appeal letters. Hopefully, this will not be one of those times.

While we were at the ped. ophth's office, Josh fooled the tech when she tried to check his vision. She was holding the chart and stepped close to him, to push his glasses up on his nose higher. During that brief moment, Josh memorized the first 4 symbols on the chart. He had a smug look on his face while he pretended to read the eye chart.
I have noticed when he does not have his contact lens in place, he will not look at the eye chart during the exam, he will look down at his lap and guess. (unless, of course, he memorized the row.) I think he knows they would like him to try, so he just guesses, thinking this will make everyone happy. When they check his left eye, his healthy one, he will look at the chart. I pointed this out to the tech yesterday. I don't think she was aware of what he was doing. The ped ophth said it is hard when your child is a frequent flyer.