For those of you who waded through my post of last week about my day trekking through the federal bureaucracy on a quest for documents, I have two things to add. First, thanks for taking the time to wade. Second, I got an update from my friend. Remember those records that everyone told him were in “the Archives” in Kansas City? Two different archives, even, if I understood correctly, one in KC and one in Lee’s Summit.
Well, he found those very records, and didn’t have to travel further than the local library. OK, the main library, the headquarters for St. Louis County Public Libraries, in the genealogy room. He found the microfiche with all of it, and got through several years without finding the naturalization papers, which he knew he wouldn’t. So now he can call the helpful woman whose name he was given and tell her that he searched and didn’t find.
No one mentioned the library. Not one employee with whom he spoke, state or federal, knew about this. Hmmm. Secret files? Good thing they hid them so carefully.
On a semi-related note, another friend is wading not through governmental bureaucracy, but insurance bureaucracy. My guess is that every single person who reads this knows someone who has had to fight over health insurance. My friend’s son was scheduled for major surgery this week, the (hopefully) final step in the correction of a cleft palate and lip. As most of you know, clefts of this sort are birth defects. Rarely does a palate or lip spontaneously split . This boy is now a teenager, and has been through all of his corrective surgeries at a large, well-known and well-funded teaching hospital here in St. Louis. Their insurance is through the same university, as his father works there. Every surgery he’s had has led up to this one, the alignment of his jaws. They started when he was a baby, and this one had to wait til his skull reached full size. He’s 17 now, and the entire family scheduled the summer around this surgery, months in advance. He held off getting a job, because the recuperation for this one is tough. Annual trips typically taken in June were delayed, and they prepared to finally get this done so that he can finish high school and put this all behind him.
Days, literally, before the surgery, she received a phone call from the coordinator of the cleft palate team, telling her that the insurance had declined the surgery. They don’t cover orthognathic surgery, or the realigning of jawbones. My friend was utterly stunned – this has been in the offing for years, same insurance they’ve had since they brought their son home. After some tears, followed by the wringing of hands and gnashing of teeth, she took a deep breath and headed to the insurance carrier’s website, where she waded through all the pages she could find, but not anything about this exclusion. She took another, deeper breath and contacted the company by phone. Through extremely nice manners and by withholding all of the rage she was feeling, she managed to find someone to pull up her file and find the applicable section: They don’t cover orthognathic surgery, EXCEPT IN THE CASE OF BIRTH DEFECTS. Oh, really? So how exactly did that little tidbit slip by? Don’t insurance companies actually examine the cases they review? This child’s entire medical history revolves around his cleft and its effect on his sinuses, his face, his skull and his jaw. How did they miss that? I guess they find it easy to just stamp DENIED across the page when they see the single word, “orthognatic,” without examining it any further. Do they not know that clefts are a common cause of this? Are the case reviewers not trained in any level of actual medical terminology? Or was this an honest mistake, an accident caused by the random human error?
I really felt for my friend – she loves this child so much, she’s advocated for him for years, and now to have this last layer of intervention denied . . . I was simply furious on her behalf. The hospital has filed an appeal, and the insurance company has 72 hours to respond.
Hopefully, in a few short days the surgery can be rescheduled in a timely fashion – but no one involved is holding their breath, because this isn’t about what is best for this child – with insurance, it rarely is. This is all about how to save the insurance company $80,000.
And the thing is, I’m sure this is nothing compared to what many have gone through. At least they weren’t denied after the fact, after they’d unwittingly dived deeply into debt. At least they didn’t open him up and then learn, at the 11th hour as he lay in surgery, that they better not proceed. At least his life is not in danger. No, he’s just a kid, a straight-A student, a normal suburban kid, a child dreading a surgery he knows is coming. And they are just normal parents, trying to help him, by paying their premiums on time and doing their best by their child.
I’ll post again when she calls with an update.
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