Friday, October 28, 2011


The lesson of the week is to not assume anything.

This is the week I decided to tackle all of our insurance options and have a roadmap set up for my son's care for every route our family could possibly take.

Route 1: Paying for care out of pocket
I don't even remember the exact numbers for everything.  My husband told me the numbers a few days ago and I started hyperventilating instantly.  It came out to be around 300-400 per visit and a couple grand for the tendonectomy.  In all it was in the 6,000 range just to get his foot corrected and his first brace.

Route 2: Deferring treatment till my new Aetna PPO takes effect on 1/1
My monthly costs are $250 for my son and I to be on this insurance.  I can see any doctor that has a contract with Aetna and I don't have to rely on a referral from a PCP (primary care physician).  The only downside of this option is that if I don't go back to work I loose this insurance.  My maternity leave ends late March/early April depending on when he decides to come.  This means I only get the treatment that I want for 3-4 months unless I go back to work.  Oh and the braces are not covered (about $300 each new pair of shoes).  This option then leads to Route 2 option A, option B, or option C.

Option A: Transfer to my husbands work insurance if I decide not to go back to work.
This seems like a perfectly acceptable option.  However he is currently signed up for an HMO which means when we switch over we are under the restrictions of an HMO.  We would have to have a PCP refer us to an orthopedist.  Sounds easy enough right?  Find a pediatrician, let him know we have been getting treatment in LA for 4 months already, and he would make the intelligent decision to then refer us to Dr. Zionts since he has been the physician treating his case.  Not quite.  Unfortunately health care is not about getting the proper's about money and who you have contracts with.  Since we have a very large Children's Hospital here in SD we would be forced to see the doctors there who we have already researched and they DO NOT follow the Ponseti protocol even though they are both on the certification list.  We would only have to do this for 4 months until my husbands open enrollment which is July and goes into effect August 1st.  In July we have the option to switch over to his company's PPO and can return to seeing Dr. Zionts in LA.  Politics is only the first problem.  The HMO options is also very very very expensive.  We would have to pay $900 a month for family health care and then the PPO would then go down to $500 a month.  Needless to say....we will be very very poor with option A for about 4 months and would have to take some money out of savings.

Option B: Go back to work
There is a part of me that feels so selfish for not jumping on this apparent option.  If I go back to work I can keep the low health care cost, continue to see the doctors I want, and be making money for the family (not that much though) so we don't have to dip into our savings.  The only negative is that I would have to find daycare which is around $1300 a month here in SD.  Beyond the cost, the huge negative is that someone else would be raising my son!  Could I even trust another person to keep his brace on all day?  I know I am married to the most amazing man in the world when he told me "You carried that baby for 9 months; I can carry the family for 4."  That totally brought on the hormonal water works.  It has always been up in the air if I was going to return to work or not (even before the clubfoot diagnosis) but I at least always wanted the financial option to stay home if I wanted to.  I don't know if that is really there anymore.

Option C: Federal Cobra insurance
It is disgusting how much insurance company's charge for people to just be a healthy human being!  When researching this option, I found out my employer pays 87% of our insurance costs.  The cobra option would be $2,000 a month for my son and I.  Needless to say this really isn't a option.

So what is the verdict?  I have no idea.  I guess I can conquer that hurdle once it comes.  I'm just happy I know what the next year will look like for our family.  I hope this situation is easier for other clubfoot parents out there because it has been a nightmare for us.  It is hard enough to cope with the fact that your child has a defect that will demand constant monitoring and medical care but then add on to the package that the proper treatment you need will cause you to go broke is heartbreaking.  Ok, that is a little dramatic.  It's just so frustrating that all the saving my husband and I have been doing is going to go toward either paying someone else to raise our child or toward insurance costs that doesn't even allow me the freedom to get proper care.  I just need to remind myself that it is only 4 months!

No comments:

Post a Comment