Of PPOs, DME and AFOs

Looks like we'll be changing insurances this open season. Three years of hand and foot orthotics have brought us to Bear's lifetime maximum benefits for durable medical equipment. I hate that they are not covered separately. There is not cap for therapy because she's under 6, why is there a cap for her therapeutic needs? It's so frustrating because we really like this insurance company.

We are blessed with federal health insurance. This allows us about a dozen options to choose from and change every year in November. Right after Bear turned one. We switched from the cheaper HMO to a PPO so we could have easy access to specialists. The referral process at the HMO had screwed up majorly 3 times. You all know that can't have that with a special needs baby. When she needs to go from the neurologist to the neurosurgeon, we can't wait around for the PCP to approve the referral and have it processed. We need to walk across the street to the surgeon's office and be seen.

It took me almost a month to find the right coverage. Of course, over the past 3 years, said PPO has been taken over by our former HMO. Coverage has changed and we are stuck. Bear is at $7,700 of her $10,000 lifetime maximum benefit. The stroller we were going to order is $2,200. That would make it very difficult for us to have any I am no playing a numbers game to find out if we can order a cheaper stroller so we'll have enough to last through next year.

Besides the stroller, we'll need at least 2 sets of custom molded below ankle orthotics, and 2 sets of wrist cock-ups and night splints. I don't think $2,300 is enough but trying to scrutinize the 4 available PPOs before December 14th frightens me. Deductibles, copays, out-of-pocket maximums and co-insurance. Figuring this out is a job in itself.

Astacia is a highly caffeinated mother of two. She is Seattle Special Needs Kids Examiner and a contributor in Chicken Soup for the Soul: Power Moms. She blogs at mamikaze.