First of all, I'm going to do what I'm soooo good at, backtrack a bit! After my last post about everything being all set to go I got sent back to zero due to someone who couldn't speak English. Now, don't get me wrong, I couldn't speak another language to save my life, so I admire people who can. But, do not work in a customer service field where you are gathering important information until you can speak it fluently. Please. This person I spoke to ended up not understanding anything I said (I wondered at the time, even to the point where I called right back and spoke to someone else) but I had no idea the damage she would do. After our call where all I wanted to know was if the splints were covered (I had gotten codes the last person I'd spoken to had asked for, which is why I was calling again) she went and spoke with a nurse and gave her some kind of misinformation which caused it to go into Bug's file that Ring Splints are NOT custom made, and therefor not covered. To make matters worse, she claimed our last set of rings made at the hospital were not covered and were rejected. Of course, she calls me and tells me all of this after I'd made the drive to have the splints measured (and had made a call on the way to Iowa City, spoke to another agent who looked at the notes and gave me the go-ahead). I was livid to say the least. The thing that upset me the most was that if she had understood even the most basic part of our conversation she would know that 1) Ring Splints exist (she had tried to tell me there was no such thing, until I told her to look at our file, we'd been having them made for 2 years already) and 2) That the whole point is that they ARE custom made, hence the 1.5 hour drive to see an OT and have measurements made, and rings ordered. I spoke to another rep, asked that the non-english speaking one not be allowed to work on our case anymore, and got a manager.
I spoke to the manager and explained that I had talked to 7 reps before this one, and all had understood clearly what I was asking about. Several had spoken to managers, or the claims departments. None had any problems with what I was saying, the only reason for the callbacks were for additional information. She looked in the file and asked to call back the next day so she could look into it all more. The next day, she calls, and apologized profusely, saying she had no idea what that last rep had been thinking/doing. She had spoken to the nurse the rep had, and had cleared things up. However, she didn't stop there. She spoke to multiple people in the medical claims area until she found one familiar with Ehlers-Danlos Syndrome and ring splints. She was able to determine that the splints were covered, and then told me that she was going to find a way for me to order them through a medical supply company so that I would not have to pay out of pocket (our order was almost $1,000) and get reimbursed. I said ok, but didn't really think it would happen. Everyone knows that the Silver Ring Splint company does not take any insurance, and Silver Ring Splints are not an item medical supply companies carry. So, I didn't hold my breath.
The next day at 8:30 AM my phone rang, and it was the head of the prosthetics division of BCBS down in Texas. She told me she was working on things, and that my "dear little girl" was going to get her splints and we were not going to pay anything for them. She said that she was dealing directly with the corporate office of a prosthetics company in Iowa, and that they would do it for us. She had me fax our order sheet, and then called me back the next day to say the order was placed and should be at our house next week. (this week now!)
I cannot say enough good things about this now. For one, I have two great contacts in the insurance company. One whom I have a direct number for. The other told me to use her name should there ever be an issue again about the rings. She also told me that now that we've done this any time in the future we need to place another order it is in the file to be handled the same way. How great is that?!?! I was happy enough to have found a couple of people who actually knew what we needed, and if it was truly covered, but to then have them go so far out of their way and actually find a way to make us not have to pay a penny out of pocket? That was outstanding! Let's face it, $1,000 is a lot of money to pay out of pocket and then have to wait and see how much and when the insurance would pay it.
So - the moral of this story is don't give up, don't be afraid to ask for someone "higher up", and keep going even if it seems like you're a broken record. If you can find the right people, they can find a way to make things happen for you!