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The Saga Continues

Broken Ankles Part II

20091113_9544 blog

When I was on the phone with our doctor Wednesday evening he asked if I could call our insurance company to make sure that a "walking cast boot" would be covered. That was his first choice of cast, but he didn't want to order one if the insurance company wouldn't cover it.

Thursday morning, after twenty minutes on hold, I was asked, "Do you know the billing code on that?". Um, no. "Sorry, I can't tell you if we cover it without knowing the billing code. Would you like me to read you  your list of benefits?". Assuming this would have some useful information (since she was offering to read them to me) I agreed. She read and read and read, including informing me our insurance covers vasectomies and any "prothesis devices" that may be associated with that. Huh? At that point she chuckled and commented that that probably wasn't very useful.

Next I called the doctor's office, hoping to get the code. "I'm sorry, the doctor isn't in today…how about you call Such and Such a pharmacy and ask them for the code, since that's probably where it will be coming from".

The lady at Such and Such a pharmacy said, "I can't tell you the billing code without knowing the exact model and size your doctor is going to order". At that point, I gave up and just made an appointment for Kalina to see the doctor the next day.

We left our house shortly after 10 AM to make our 11 o'clock appointment. I was eager to get her ankle covered since the previous day I had to issue the following instructions: don't run down the stairs, no you can't play outside, and get off that skateboard! Yes, I wanted to get her ankle covered.

For various reasons, our appointment took an hour and a half…and the doctor wrote a prescription for the cast from a local prosthetic company. * by the way, I got some very interesting comments on the on broken bones after my last post. It's true that if I didn't take Kalina in for x-rays, we wouldn't even know it was broken…the doctor commented that of course people break bones and walk around not realizing it…but at the point that you know a bone is broken, it seems a bit foolish to say, "well, she's walking on it, we won't bother to protect it now".* He told me to call and make an appointment to get the walking cast put on. I called and was told, "Oh, she would need to see our orthopedic doctor for a fitting…and he won't be in until Monday". 

"Oh…my daughter's ankle has been broken since last Saturday and it's not covered, I'd really like to get it protected". 

"Daughter? How old is she?"

"Eight"

"Oh. We don't stock them that small. We'd have to order it and it wouldn't be in until the middle of next week at the earliest.

So I called the doctor's office again. The doctor said to just take the prescription to Such and Such pharmacy…he called and made sure they had one, in her size. By this time I had picked up the children from my parents, so we all went to the pharmacy. When we arrived I said, "this is a pharmacy…we can either all go in like a parade, or some of you can wait in the van". Several older children opted to wait in the van so I only had to take seven or eight children in with me. 

I handed over the prescription and the lady asked for my insurance card. After a quick glance, she said, "oh, I'm sorry, we can't bill to that insurance company". After some negotiation, she said, yes, I could pay upfront and submit the bill myself. She looked at the prescription and said, "I'm sorry, we don't have this in stock". 

"But my doctor called! He said you had one."

"Yes, but he didn't specify a 'short boot', and this says 'short boot'. We don't have one of those. Do you want me to call Such and Such Healthcare, to see if they have one?"

Now it was well into the afternoon. I loaded my children back into the van and considered my options. Do I drag them all to the other side of town in search of this boot? Or take the home, put my little ones down for naps and leave the older girls in charge? I opted for the latter.

So I drove all the way home, dropped off children and headed back into town. After a moment of consideration, I also exchanged my fifteen passenger van for my Jeep Cherokee. That proved to be a wise decision as Such and Such Healthcare was downtown on a one way street with parallel parking only. I was thankful Kalina could walk on her broken ankle…since we had to park a full half a block away.

Finally, finally, we were able to locate the proper "walking cast boot"…and head home. We didn't arrive home until after three o'clock. 

Whew, it's exhausting just to type all of that out. A day like that doesn't leave a whole lot of time for school work. Let's hope for a calmer schedule this week…

5 Comments

  1. Nicole

    Wow. That’s really awful. Stupid health care and well I want to say bureaucrats but I don’t know if that word really works here. I hope your daughter feels better, at any rate!

  2. Lou

    I had to wear one of those funny things! they are stinking hot in the middle of summer, but I guess it’s getting cooler for you guys. Hope she feels better soon and can refrain from skateboarding, running etc!
    Lessons learnt from your outing:…um…how to deal with bureaucracy…patience…that sometimes people/organisations can be very annoying….um….

  3. Kristi O

    I had to laugh, I have lived in those shoes but on a much smaller scale. I am praying right now that somehow God will richly bless you and blow your socks off for all the smiles and gave out that day when many would have choked some of those you were in contact with. i am a lurker on your blog. I am so blessed by your large family and its adventures. God bless you.

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