Insurance Woes

My dad visited Henry this morning and said he looked great. Carol is his nurse today.

I called the NICU to get an update. I wasn't feeling well yesterday, so I didn't go into the NICU last night and am holding off until tonight. I don't know if I was really sick, just ate the wrong foods, or was just tired. I hate not going into the NICU to see him. But I can't take the chance of getting him sick, or any other baby sick for that matter.

Carol said that Henry had his eye exam. The doctor didn't find anything alarming. In other words, Henry's eyes look fine for his gestational age. It is common for preemies to have eye problems. But these eye problems don't appear until a little bit later. The eye problems occur from giving them too much oxygen (too much for the eyes, but obviously necessary for breathing) and from grow spurts. As I understand it, the capillaries in the eyes sometimes constrict, and this sometimes results in retinal detachment. They try to minimize the problems with the vessels with laser surgery. Sometimes these problems don't appear until after the baby is taken home. The eye doctor visits Henry once a week.

Carol reported that they are increasing the calories in the milk to 24 calories per ounce (2 more ounces than yesterday).

In other news, I'm trying to sort out some insurance problems. I received a call from UMC last week, Tuesday I think it was. The NICU social worker Laurel had told them that Henry had been covered for the standard 30 days but wasn't covered after that. I have no idea why the social worker didn't come and talk to me first. But this resulted in UMC calling me, obviously concerned about payment because his NICU stay is expensive. I told them that of course I had coverage for him. I called my Schaller Anderson case worker, Rhoda, to see what was going on. I explained that I had enrolled him through the UA benefits office well within the 30 days limits for qualifying events and had the confirmation email to show that he'd been logged into the UA benefits system as of 5/21 (I dropped off the paper work on 5/17). As near as Rhoda could tell, there were problems because some claims were filed under Henry and some were filed under Henry J; the Henry claims were getting rejected. His account is listed under Henry J, not Henry. So she told me to call the number on the back of my insurance card to sort it out.

On top of that, I received a letter from the insurance company stating that they weren't paying some testing done on 5/2 for Henry because he needed to be pre-certified. Considering that he's obviously inpatient and my emergency delivery was pre-certified within the time frame, the idea that I would have to pre-certify every single test done for him while he is in the NICU seems to me rather asinine.

I called the Schaller Anderson office today to sort this out. The customer service representative said that the Henry versus Henry J wouldn't be a problem. But we might have some hold ups because his claims are often coming under my last name, but the records have him listed under Jeff's last name. Officially, they admitted Henry into the NICU under my last name because they coordinate the babies with their mothers' names. We didn't filled out the birth certificate information until two days after he was born (5/2). At that point, his last name became his father's. I copied his birth certificate information for UA benefits, so they should have both our last names on file for Henry. But I suspect this might be an ongoing battle, although several of his claims have been paid. Some get put on hold, others do not. It is a mystery how they choose to pay some but not others.

In addition, they haven't validated Henry's pre-certification for his NICU stay because the hospital hasn't given Schaller Anderson a release date on Henry. I told the customer service representative that they weren't likely to give a release date because it could be anywhere from two to four months away. This is somewhat problematic because the letter on one of the claims requiring pre-certification says: "This claim will be pended for 60 days awaiting pre-certification. If no pre-certification is filed withing 60 days a denial letter will be sent." Well, what if the doctors don't give the insurance company a release date within 60 days? The customer service representative said that it should be OK because the pre-certification is on file but it hasn't been validated. So hopefully, being on file will be enough.

My mom is going to spend time with Henry this afternoon. She'll give me the Henry report when she gets back. That's all for now.