cost of conformer... need an opinion

[romybeth]

We have a situation that we would love feed back on.

When oue son was diagnosed with Micropthalmia, our Opthomologist sent us to a woman occularist who comes to our town, but is based out of state... problem was, she was also out of out insurance network and we were hit severly with medical charges for each visit. We paid for all of our visits ( $75 just to sit down and chat with her each time) and a deposit of $525.... She originally gave us a "stock" conformer, and when she made a new one for him, took the old one back. We are now, 7 months later, getting a bill for $525 AND have had our deposit used.



We have since moved to a different ocularist, since January 2006. He is wonderful, know that woman we used to go to. He makes our son's conformers look like the real deal, and only charges up for a "serise" of them.

We spoke to him about this bill we received and he is of the 'professional opinion' that she is trying to rip us off, as we have 1 conformer, but are being charged for 2, as she took back her 'stock'eye. It has been suggested to us that we write her a letter, along with one to the ASO, expressing that what she is doing seems unfair and unethical, as we all know our babies need many conformers when they are little. What do y'all think??

Id love some feed back, opinions and shared stories. And has anyone found any kind of financial help to pay for all of these conformers in the early years????? Seems insurance doesnt take into consideration how many a baby needs in his/her first years of life.

TIA!
Romy

[Leatta]

We were able to get help with the cost from Children's Miracle Network and the First Hand Foundation (in Kansas City) while we argued with our insurance. Our doctor wrote a letter explaining the future problems which our daughter might expereince including fluid on her ears, sinus problems, infections and facial adnormalities due to bone growth and empty space.

We then filed an appeal with our insurance. When they denied our appeal, we filed a complaint with our state's insurance commission. After our compaint (this was our second--our first was over getting a certified ocularist), the insurance sent us a letter stating that after reviewing all the facts in the case, they would not limit the number of "newly fitted different sets of conformers" (a fancy way to say, they would not replace lost ones).

[ohbilatmicromom]

Wow, that sounds terrible! >:( Occularists are definitely difficult to find and a good one is even harder to find. I would definitely send her a letter explaining why you are NOT going to pay the bill. If your current occularist feels comfortable enough you could even mention his name in the letter and how his office bills. I have always had to fight with the insurance company to pay for all of my son's medical bills, which gets quite frustrating, but my persistence has always ended with them paying. I do believe our son was charged for each new set of conformers, but he added to one set so it was just the normal fee. Our son is unique in the fact he has bilateral microphtalmia with some vision so his conformers are clear with no eye painted on. I don't think that makes a difference though in how they are made. They are just the shell without an eye painted on. I would DEFINITELY send her a letter stating why you will not pay this fee. Describe your unhappiness with quality of care also.

Not sure where you live, but there are services that can help, but not many, and you have to qualify for most of them financially. Locally, we have Bureau for Children with Medical Handicapps and Sunshine Children's home. You should also have Early Intervention and and EIS who can give you the information or set you up with the right services. If we use a doc in the BCMH network they will cover whatever insurance does not, but the doc has to be one of their providers.

Good luck
Michelle