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.