Well, I know it has been some time but my accounting project was a killer and I had to focus a lot of energy into that. Afetr working on that each day and playing with and cleaning up after the kids there just wasn't much time left. I have turned it in so will once again have time to dedicate to my blog.

Some great news, we are almost through the program! I am trying to keep from getting too excited because there always seems to be another roadblock.

I left off of my story at the beginning of this year so I am going to begin to blend what happened then and currently because it is just so convoluted that it seems like it will be easier for me to get it in writing that way.

At the beginning of this year I was so frustrated! It had been a year and a half since the Special Master decided in our favor and almost a year since the Life Care Planners (LCP) had been here to visit with our family. I think I explained how little time was actuaqlly spent with us but it still bothers me so I thought I would mention it again.

Well, I find out that they are still "negotiating". That term ended up being like a burr under a saddle. It almost pained me to hear it because I heard it alot. My first thought and question to the attorney was : I thought they were negotiating last year. What could possibly take so long. Also, I was told that there would be so many questions that I would be sick of being on the phone with the LCP and her office. But I haven't spoken to them but once or twice.

Now I am just getting irritated because I thought things were moving along and I am now well aware that this is a slow process but this is ridiculous. So I started to push. I kept calling my attorneys and my LCP. I am told that the governments LCP was taking awhile to submit her proposal or life care plan or whatever they were calling it. So finally, she submitted her side.

How ridicullous! This is when I figured out how ridiculous the system really was. One of the points of contention was a vehicle. I was told by both LCP's that we would never have to worry about transporting her to appointments again because they both were going to make sure that a vehicle would be put into the plan that would fit our whoel family so it would no longer be so burdensome. But in the plan was a minivan. The government LCP said that was all she needed since her caregiver (CNA, nurse, etc) would be able to transport her everywhere. Total disregard for the fact that we are a family and the fact that we do things together. We have never excluded Angelica. She has gone on every vacation we have been able to go on, even camping. Why would we all of a sudden start havign someone else be her main caregiver as though we aren't here? We aren't putting her into a group home. She is a part of our family. Also, which parents do not go to any appointments or therapy visits? Am I just supposed to give my under 10 child a kiss goodbye and see her when she gets back? NO! We are active parents with an active family who do things together. Before it became so difficult to transport, she even went grocery shopping with me.

Also, they refused to pay for mileage, which should be covered. Their reasoning was that they were giving her a vehicle but didn't need to pay any expenses related. Ummm....hello....would she even need this vehicle if we had not followed government issued protocol and allowed my child to be vaccinated, which ultimately led to her debilitating condition? So it stood to reason that the maintenance and mileage should be included. They weren't giving us a vehicle big enough for the family so this is just hers. We have no extra money to support an extra vehicle, especially one we wouldn't even be using. They didn't care.

They also have a sneaky way of not paying for much. As I looked over the life care plan I noticed that the government had zero dollars for most items. I now find out that they only pay for anything above and beyond insurance. They base it on current insurance and the government pretty much assumes that insurance covers everything. Our insurance has a maximum out of pocket of $5000 a year so the government was giving her $5000 then everything else will be 100% covered since we would have met our out of pocket maximum (hope that isn't too confusing). Problem is that they assume everything is covered by insurance, also they don't take into account what amounts actually go towards out of pocket maximum the way the insurance company does.

I was sickened by how much would not be covered, many of them big ticket items. Any reasonable thinking person knows that insurance does not cover everything and how hard it is to get payment for things that are covered.

So, I got angry. This is one of my little victories through this whole process. I still smile thinking about it. I called our insurance company and ask them to please help. I explain what the life care plan is all about and what the LCP for the government was trying to claim. I begged for their help since we were all aware that there were things that would be denied.

I was shot down over and over but I kept pushing, asking for different departments, someone higher up, anything. Finally someone offered to try to get the information I sought. I recieved a call later that day from the director of Blue Cross Blue Shield of North Carolina who was joined by a member of their legal team and the rep I spoke with earlier. I clearly explained that I was not asking for a guarantee of payment but I knew there had to be some inner office guide or company policies in place identifying which , equipment, services, etc. would be denied regardless of medical necessity.

Well, need to take care of the kiddos. I will try to get back on todau to pick back up. We are just getting to the good part. :)