My husband lovingly calls me his bulldog. He knows that if he needs to get things done that may seem a little harder to achieve, that it falls under my umbrella of specialties.
The truth is – I don’t know any other way to be. Our latest medical roadblock came after we got the news that in addition to all challenges my middle princess already had, she needed to start growth hormones. The way the journey to getting the meds approved by the insurance company was how all things medical seem to go for us, painfully.
It went a little like this:
- We got the crappy news.
- We were told a 5 hour hospital test was required for insurance to cover said meds despite there being a medical need.
- World-wide pandemic hits – 5 hour test gets cancelled.
- Dr.’s office filed an appeal – it was denied.
- Someone from the insurance company called me to tell me about the denial.
- l spent an hour on the phone with this person explaining my daughters medical situation to him. After listening to her story, he told me that there is an over-ride for Covid – 19 that we could use.
Despite having this knowledge, I was told over and over and over it wouldn’t be possible to get the medication we needed using this over-ride.
- I spent over 3 hours on the phone with a million people explaining how to use the over-ride. I eventually found someone who would actually listen to me.
- I finally got a 25 day supply of the medication covered using this over-ride.
- The insurance company denied the doctor office’s second appeal because we didn’t have the 5 hour test. Let me remind you that we couldn’t get the test because the hospital wouldn’t allow it.
It was at this point that I knew I needed to pivot and try a few different things.
1) I researched if there was any way to get the medication short term from the drug rep.
2) I asked the NP from the doctors office who was AMAZING to see if she had any ideas as to how we could get the meds (which she did).
3) I replied myself to the insurance company’s denial with a 3 page long appeal. I was strong and accurate with why she should get the meds and how the information they were using to decide eligibility was wrong.
After over 10 hours of speaking to so many different people we got an approval within 24 hours of sending over the appeal.
If you are still with me there is a purpose to my story, I promise.
Every challenging situation you will find yourself in will more than likely go as follows:
Problem ➡ Roadblock ➡ Research ➡ Pivot ➡ Success
No matter what situation I have found myself in throughout my adult life – job loss, finding my soul-mate, infertility, 135 day NICU stay, breast-cancer, getting coverage for expensive meds for me or my children and so much more – has followed the path above.
The sooner you prepare yourself for the fight you have in front of you the better off you will be. You need to pass though each of the steps, they are required before you move on to the next.
- You can’t have success without a pivot.
- You can’t pivot without doing research first.
- You do research when you run into a roadblock.
- And every roadblock starts with a problem.
Each step builds upon the other and therefore should not be skipped. I know it’s tempting to hit a roadblock yet still expect a positive outcome but don’t. It’s through this process you learn more about yourself and how strong you can be.
Below I have attached a snippet of an email I just received from the drug rep. who helped me for the past month with our case. Getting a note like this made my heart tighten and my eyes leak. It’s so easy for me to be this way when it comes to advocating for me and my family. I don’t know any other way to be. Throughout my life, when I was faced with challenge after challenge I kept my head down and my eye on the prize. Many times I was alone in this journey without having the support or faith of many around me. I never doubted my abilities and neither should you. Sometimes you are too deep in the thick of your problem to take the time to celebrate just how strong and how far you have come. Somehow during this time of social distancing and isolation I forgot who I was. I hope this serves as a reminder to you too that every problem if handled properly can be solved and bring you success.