Fight of a lifetime.....

Greetings friends, prayer warriors and faithful followers,

I'm not really sure of where to start here. First let me just start by saying, We have come to the decision that it is time to pull Amelia out of school. It was a tough decision, but with her current counts and knowing that transplant is, one way or another, 6 months away, it was a much needed choice. She hasn't been too sick and we want to keep it that way and we know that this is cold and flu season. We just want to avoid her from getting anything that could hinder her health or the transplant for that fact. So prayers there are needed all the way around.

on to the second front, the insurance, we are still fighting to get this child the coverage she needs to get to Minnesota for her transplant. We need to get to Minnesota, in my heart and soul that is where I know that she will have the best chance at surviving. With that being said, I was in conversation with Dr Wagner and we were talking about some of the new Obama laws that have been taking affect. One of which is the law stating:

Restriction On Annual Dollar Coverage Limits

In general, employer plans can't impose annual coverage limits of less than $750,000 for "essential" health benefits, including hospital services, drugs, emergency services and maternity and newborn care. The maximum limits increase every year and they are eliminated in 2014. These limits apply to new individual policies, too.

Additional provisions take effect on or after Sept. 23 for new plans offered by employers or purchased by individuals since March 23. These include requirements that insurers:

--Cover the full cost of preventive services that have the highest recommendation of the U.S. Preventive Services Task Force.

--Allow women to see an OB-GYN without a referral.

--Do not make plan members pay higher co-payments or coinsurance for out-of-network emergency services.

For more information about the provisions that take effect for plan years beginning on or after Sept. 23, go to healthcare.gov.

Now from my understanding of reading this means that as of September 23 2010 when our policy renews in July that her transplant cap should be increased to $750,000. So trying to figure that out we called the Sheriff's office department of health ins trying to see if they new if that was indeed the case, because if that is our goal date than we would do all we could do to keep Amelia "healthy" and be ready to go to transplant at that time.
Well this is when we go fired up, the insurance rep that we talked to said she didn't know that she would call the Louisiana Sheriff's association's rep/liaison and see what she could come up with. Well below is a copy of the email that I received from her....
Mrs. Bennett,

Below is the response I got from the LSA's representative:

"As of now, nothing has changed. Therefore, if she tried to get an approval - BCBSLA would deny and so would the LSA. And since the Bennett's have exhausted their 1st level and 2nd level appeals regarding this benefit - they have no other channels to go unless they wish to obtain an attorney and sue the LSA.

As far as the max being lifted this renewal - as you may know, the Obama gunk has several issues and each issue has a different date to be effective through 2014. I have no idea if the "lifting of maximums" is scheduled for this year or in 2012, 2013 or 2014. As soon as I/the LSA know(s), each parish will be made aware.

Sorry I could not offer any "better" news for the Bennett's but as of now, there is nothing they can do."

I'm really sorry. If I hear or find out anything else, I will let you know. Our prayers are with your family.

Sincerely,

Well that just put gas on the fire for me! First I have no idea how we have exhausted our first and second level appeals. If calling and asking them to let us use her lifetime maximum is an appeal well then they need to re-look at their policies! The to flat out state that we have nothing left to do but to get an attorney and sue them!! What a cold hearted bitch to have written this!!! To tell a parent that no you can't do anything about it, to have to sit and watch your child dying. How cruel can some one be. If this was going to be her response I think she could have and should have done it with a little more tact!!! I am so beyond pissed right now. We immediately called the sheriff to request a meeting with him in hopes that he may have some kind of info for us and to also inform him that we are going to the media with this, the insurance commissioner and where ever else need be if it comes down to an attorney then so be it!!!
She called the laws, Obama gunk, but more importantly isn't it her job to know these things. I, just a stupid house wife and mom, found the law why can't they. They are hoping that we are going to crawl under a rock so they can get out of paying anything...well this mamma isn't going away. I'm taking Amelia with me to every meeting that we have. The first one up is the Sheriff tomorrow, and if we get the chance to appeal in front of the sheriff's association she will be there front and center to look all those old retired sheriff's in the eye and have them tell her no!!! They are going to tell it to me they are going to tell them no there is nothing that we can do to give you a fighting chance at saving your life!! If they can sit there and tell an innocent child that they can not or rather WILL not help, then they are not men at all!!!!

you look at this face and then have the guts to tell her no there is nothing we can do to help you fight for your life....



We have a fight on our hands so, I am asking for some much needed prayers. Prayers for this to resolve in our favor so that Amelia can get her need transplant in Minnesota where they have a 100% survival rate for children under 10 years old. Prayer for Amelia's health and counts to continue to hold till we get the answers we need, pray for my sanity and for the strength, and wisdom to keep the fight going, not just for my child but all children who are not receiving the proper care because the insurance companies just wanna make their pocketbooks fatter!!
Thank you so very much.
Blessings,