Illiana Galean (illiana_galean) wrote in bad_service,
Illiana Galean
illiana_galean
bad_service

Brief summary, TriCare is the insurance for military members and their dependents. It's cheap, and on a general level, not to bad. You eventually get used to rarely seeing the same doctor twice, and jumping through hoops for a referral. But for emergencies, there's never a problem. Maybe I was just spoiled, and had skewed expectations, because our last post had a full hospital, with everything a family could ever want or need, on post.

But now....

On September 21st, my three year old son (will be four in December), woke up at midnight thirty screaming bloody murder. This is so far out of the norm for him, it scared me. But what terrified me further, was the fact that he was gasping, his chest was rattling, and he was turning blue.

This elicited a, "HOLY SHIT!" moment which caused me to barge into the bedroom and start flinging shoes and clothes at my formerly sleeping husband, who got dressed as if the house was under mortar fire. Within six min. we were all dressed, and rushing out of the house.

Per TriCare's shitty ass rules, we rushed to the nearest Army hospital, which was an intense drive of forty-five min. away. (We're stationed at a "satellite" post) We made it in just under thirty.

At this time I can only thank all the Gods in existence that my brother was visiting and could tend the elder children. Who fortunately slept through the whole ordeal. And those same Gods for sending the State Troopers, Highway Patrol, regular police, and MP's elsewhere during that drive. That road is patrolled by four separate entities since it's an on/off post road and happy hunting ground for poachers and speeders.

I will also continue to offer sacrifices to the Gods for the ER being completely, 100% no patients waiting, or in process of being seen, blessedly empty. We had the whole place to ourselves when we screeched to a halt, and ran inside carrying our son.

The Army was awesome in that they rushed us to the back, slapped an albuterol mask on my baby boy, and only then did we have to do any inprocessing. Squish, thought the "rain mask" was insanely cool, and didn't take it off, and getting pictures of his insides was awesome. He loved the "hug band" (blood pressure), and was even good for his IV. The staff (soldiers and civilians alike) at Winn Army Community Hospital was so amazing, I can't even come up with the words to describe the sheer levels of awesome, and will forever sing your praises.

When x-rays showed nothing, and he was still rattling and turning blue (we were on our seventh dose of albuterol at that time, and it was the only thing keeping him breathing), the decision was made by the CO on duty, to call an ambulance (Squish loved "his flashing truck") and have us transported to Memorial University Medical Center for admittance to the PICU, since Winn doesn't have one.

Memorial's right up there with Winn as far as awesome and fantastic goes. After more x-rays, albuterol and oxygen treatments, blood work, urine samples, every test under the sun a toddler should hate, but my boy thought was a grand adventure, the decision was made to do exploratory surgery into his lungs to figure out WTF was making him rattle and turn blue.

So forms are signed to schedule the Bronchoscopy as early as possible (four hours later), I'm sent to the hospital psychologist because I'm flipping out and feeling like the worst parent in the world ever, we talk to the PICU liason, the anesthesiologist (They used two kinds, a general numbing agent, plus putting him to sleep), and eventually the surgery happens.

They find a peanut.

Queue WTFery all around, because we simply cannot figure out how a peanut got in there, nor can we ever recall even giving him anything with peanuts, creamy peanut butter not withstanding. We even interrogated my brother and my daughters, and nothing. They wouldn't give him peanuts anyway because it's a choking hazard.

Squish comes out unscathed if a little raspy. Is no longer rattling and turning blue, back to his overly happy and playful self (he was still happy and playing during all this, but more so after the Bronchoscopy), and we're released the following day, after scheduling a follow-up appointment with the clinic here on post. Which we got further all clear on, and everything is wonderful.

Only not.

Weeks pass, and I get a letter from TriCare requesting further information about the incident, so I fill out the form and send it back. Next day I get another, and send it in too. Next day? Yep! A third! I walked that one into the TriCare office on post just in case. After that (day four), we get a bill for just over $10,000.00 which no one will do anything about or explain. That is until my husband goes into the office with his First Sergeant in tow.

Thinking everything's been taken care of, because foolish us, we believed them when they said it was, we go about life. Only to freak out when we start getting bills again. And more bills. And even more bills. Each one of them for individual services, which eventually total to the amount on the initial bill. Oddly, my visit with the hospital psychologist isn't one of them. Go figure.

Why? Because TriCare deems the whole thing, especially the Bronchoscopy and anesthesia (Yeah, try sticking something down anyone's throat into their lungs and see if they sit still, let alone a three year old) as "optional and un-necessary". Basically what it translates to is, "Should have just let your kid die. Any and all treatment was completely un-necessary." They're even trying to charge us for parking in the "Free Emergency Patient Parking" area at Winn.

So now we're fighting with TriCare to set this right, because there's no way in hell we can afford this. It's why we went with the version of TriCare we do have. Which works in that so long as you start at a military clinic/hospital (unless you're travelling and out of "range"), all treatment is covered 100% no questions asked. No co-pays, etc.

We have documents and forms from Winn and Memorial detailing out exactly what was done, why it was necessary, absolutely everything, and TriCare is still calling all of it "optional treatment" and refusing to pay up.

So now we're racing against the clock, because TriCare will pull their payments from the paycheck, in full, for however long it takes, leaving us with no money and only a, "To bad, should have paid your bill." response. Even if it isn't our fault, and it will take months, even years, to get that money back.

This, this is stress I do not need. Ever.

Sorry, got very, very long. Thanks for reading this far.

tl;dr
Three year old nearly stops breathing in the middle of the night, go to Army hospital, get transferred to civilian hospital, have tests and surgical treatment done to save kiddo's life, insurance refuses to pay deeming all of it "un-necessary and optional."

I want to scream, break things, and cry.
Tags: *medical/pharmacy
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