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Feeding Clinic Evaluation and Insurance

Wednesday, September 8, 2010

Well, we've been told to keep our Baylor Feeding Clinic evaluation for September 20.  However, at this point, we are still hammering out the details.  

A few weeks ago, Breck filled out the necessary paperwork (aka packet) to send in to the Clinic so they would have alot of background and history on Bennett for the evaluation.

We turned in the paperwork and expected to arrive for our evaluation in a few weeks.  However, we received a call a few days ago from the Baylor Feeding Clinic insurance lady letting us know our insurance doesn't have a contract with the Baylor Feeding Clinic. 

We were so disappointed to think that our opportunity to go to the Baylor Feeding Clinic was no more since insurance wouldn't cover it.

We decided to call our insurance company to see if possibly there was a similar Feeding Clinic in Austin that might be covered instead.  After research and a phone call to the insurance company, we realized Austin does not offer something similar.  In fact, the Baylor Feeding Clinic in Dallas is the only of its kind in the Southeast and is top rated at what it does.

This made us even more sad to think we were going to miss this opportunity.  We called the insurance company and they told us that there is a chance it could be covered.  So, we called the Baylor Feeding Clinic insurance lady back and asked her to contact our insurance and see about entering into a contract with them especially for Bennett (apparently this is something that can happen if it is determined that the insurance company does not have a contract with a similiar provider who could do the job).

We were so relieved to know that the Baylor Feeding Clinic evaluation was not going to be cancelled afterall.  There was a chance all would be well.

So, we were again disappointed when the Baylor Feeding Clinic insurance lady called to say our request was denied by the insurance company.

A call to the insurance company seemed to send us in another direction.  We called and spoke with their appeals department.  The kind lady there called back to ask us questions and better understand our needs.

Breck explained to the lady why we have chosen the Baylor Feeding Clinic, why we feel that normal speech therapy is not good enough and why we feel Bennett is ready for such a step.

The lady seemed impressed with our efforts and knowledge.  She seemed happy with everything we had done so far as stated our request to use the Baylor Feeding Clinic seemed "appropriate" for Bennett's needs.

The last stop in the process now was to talk to the Insurance Medical Director and see if he will get on board...despite that technically he already denied our request (apparently a denial can be overturned at any time).

So, we are still waiting to hear back from our Insurance company but our fingers are crossed.  The best thing about this situation is that we have three fabulous doctors that are very supportive of our decision to take this step - our GI doctor highly recommends this Feeding Clinic - and the Feeding Clinic's director is phenomenal.  She seems like she will fight for us and really wants to find a way to make it all work.

The Baylor Feeding Clinic is two hours away (in Dallas) from our home - an hour in the opposite direction of Bennett's CF Clinic (in Fort Worth).  So, we aren't exactly sure how we will make it work - how it can work or what it even means to work.  But we hope to at least have our evaluation to find out.

We have been told that once outpatient therapy can get Bennett to a specific place, we will be admitted inpatient to the hospital for about 5 weeks to completely wean Bennett from the g-tube and on to oral-only feedings.  (Isn't that completely exciting?!)  It may take a year or more to get Bennett to that point...but the hope is that eventually Bennett will be able to eat without using the tube (or at least without using the tube for the bulk of his feedings).  We will see what they say in two weeks.

...at least as long as we get the ok from the insurance.  For now, everyone - insurance and feeding clinic staff - say "keep the appointment."  The hope is we will be there on September 20.  We're praying for good news soon!

2 Responses to “Feeding Clinic Evaluation and Insurance”

  1. Will be saying a special prayer for this need for Bennett. Love, MS.Ann

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  2. Hey friend - if this happens, know that you have a friend in Dallas who would love to help you out - I can bring you food, take big brother to a park.... Just letting you know to contact me if you need anything. :)

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