Today the guys delivered my deluxe thumb stabilizer. Hooray!! I did mental cartwheels!!

So the story is that my OT recommended this type of doodad for my hand,submitted it to my pcp,who passed it along for authorization by insurance. Insurance denied it but authorized another kind of doodad. This one cost $150 to the insurance compared to the other one that was about $20. I tried their only authorized one for me and it was too long,too rigid,too heavy,and very uncomfortable. I tried it when OT said it was a nice one,but eventually it was evident it was making my discomfort worse rather than better. So OT started the authorization process again stating new reasons for the type she recommended. I was keeping in touch with the insurance and one day I was called and told it was only at drug store pharmacy and did not need a pre auth. So I went to a pharmacy,they ran it through insurance for purchase,and it was declined. This was after finding out the prescription was not at my pharmacy, and waiting for doc office to fax it. I called insurance and was told it needed a pre auth plus it must be purchased at a medical supply and not a pharmacy. So I left feeling like Alice in Wonderland. I called customer service,formally complained but was told there was no record at all for a request of a second splint. I formally put in a complaint at state level online after talking to screener. I talked to customer service many times,waited,nothing. One representative said they had spent enough time trying to locate a med supply that provided what I wanted and it was just not covered. So at the end of my OT sessions,my OT was disgusted with my experience and gifted me a sample doodad she had in the office. She said it was a secret, but it was a duplicate sample she had. It was similar to the one she recommended with a little more support but still flexible,wrist length, soft material. I was very grateful for her kindness.

Then out of the blue,insurance supervisor calls and said you got your hand thing right. I said Nooooooo. So she actually followed through and had the correct doodad delivered to me! They were unable to find it,or a similar one at a medical supply. So the med supply ordered it special and the insurance was satisfied it could pay a bill to them and not the pharmacy it probably was purchased from. But the first delivery was not the exact style so I did not accept it. They delivered the correct one today.

So the reason I list every little detail of this process is due to the final words of the supervisor at the insurance office. She apologized and said they usually do not run into special authorizations and special deliveries. I said, well no, you guys Bully people out of things that should be covered.

They make delays with lost orders when I kept copies of the papertrail and made calls to follow up. Most people will pay out of pocket if they can. I think insurance saves loads of money that way. All they did to me was just excuses. I tried the covered one and since it did not work out,it was reasonable to provide another type. It was not ok to say well if you want something else,then you pay.

I went through a similar situation getting my shiny red walker. I was told insurance would not pay for a second walker. My PT argued that I was ready to progress from 2 wheels to a 4 wheel with hand brakes and a seat rest. It took months,but I got it. I run into people telling me they purchased their own.

My OT encouraged me to press the insurance for what I needed. I constantly go around with them to cover or switch to covered drugs,services,supplies. I have an endless amount of time to hold on,a fearless belief that insurance Can prevent stuff if they do help with basics.

So I encourage others to be persistent,ask for help,jump through their hoops so you get what you need.