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  #1  
January 1st, 2007, 10:03 PM
m.and.a
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We have two. Apria, which SUCKS, and Medirents, which is okay. I'm sticking with them because they didn't require we do the normal two week mandatory training in the hospital on the vent and even accepted a new vented child. (Aleah has since come off the vent). They are in MD, we are in VA. So far they've been pretty good. I had Pediatric Connection, which I LOVED, but when DH's company switched insurances, we had to go back. Now that our DME insurance coverage has run out and Aleah is now on the VA Technology Waiver, we could go back to pediatric connection, but I'm just too tired for the hubub.

Anyone else have dealings with DME suppliers?
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  #2  
January 3rd, 2007, 07:49 AM
*Lindsay*'s Avatar Platinum Supermommy
Join Date: Apr 2006
Location: Virginia
Posts: 12,516
No, we don't have any medical suppliers. Man you must deal with so much huh? How stressful! It sounds like you handle it so wonderfully though!
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  #3  
January 4th, 2007, 09:42 PM
m.and.a
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I take zoloft.
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  #4  
January 5th, 2007, 08:04 AM
*Lindsay*'s Avatar Platinum Supermommy
Join Date: Apr 2006
Location: Virginia
Posts: 12,516
Quote:
I take zoloft. [/b]

Hehe! Me too-I wouldn't be able to function without it! Actually I am on Prozac, but pretty much the same thing!
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  #5  
January 5th, 2007, 04:03 PM
m.and.a
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Imma go a little TMI here, but the zoloft is killing my... um... marital activities if you catch my drift. I'm looking for a new med.
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  #6  
January 5th, 2007, 09:14 PM
*Lindsay*'s Avatar Platinum Supermommy
Join Date: Apr 2006
Location: Virginia
Posts: 12,516
Quote:
Imma go a little TMI here, but the zoloft is killing my... um... marital activities if you catch my drift. I'm looking for a new med.[/b]
Not tmi for me! I know what you mean. Sometimes you kinda have to work through it. It is not as bad for me as it was initally, but then again, having a baby made me not want to do it for a loooooooong time!
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  #7  
January 6th, 2007, 09:33 AM
trisha4005's Avatar Veteran
Join Date: Oct 2006
Posts: 116
Quote:
Quote:
Imma go a little TMI here, but the zoloft is killing my... um... marital activities if you catch my drift. I'm looking for a new med.[/b]
Not tmi for me! I know what you mean. Sometimes you kinda have to work through it. It is not as bad for me as it was initally, but then again, having a baby made me not want to do it for a loooooooong time!
[/b]

I took Lexapro for a while, but it has the same effect. Now I'm on Wellbutrin and it's working great. I got *some* of my sexy back
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  #8  
January 6th, 2007, 04:24 PM
m.and.a
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Mebbe I'll ask about switching. Thanks!
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  #9  
January 10th, 2007, 08:11 PM
*Lindsay*'s Avatar Platinum Supermommy
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Posts: 12,516
Quote:
I got *some* of my sexy back [/b]
LMAO!!!!!!!!!!
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  #10  
January 13th, 2007, 02:52 AM
kittycat's Avatar Platinum Supermommy
Join Date: Jul 2004
Location: Chicago, IL (W Burbs)
Posts: 12,488
We use LifeTech (local to Chicago area) for DSs enteral equipment. We used to have them for his oxygen needs, then switched to Apria when we needed smaller tanks (below D-tank) for lower flow oxygen, but we kept the suction machine and sat monitor with LifeTech. DS has been off the oxygen for a little over a year now, so we're only using LifeTech. however, I get my formula (nutren jr), syringes, g-tubes and extensions through Allegromedical.com. Their prices are considerabley lower. With Lifetech, we were being charged $8.50 for one 60CC feeding syringe (before we switched to the pump). Through Allegro I was able to order the identical syringe for only 65cents. 5cc syringes were $5.50, I get 100 for $20 now.

We're switching insurance companies in March though, and they'll only cover DME 80%, so we're trying to find out if they'll purchase DSs feeding pump vs. us having to pay the rental cost, because LifeTech is ripping us off there (around $700/mo). Of course it all goes through insurance, but we do have limits, so we've tried to bargain shop where we can - thus my ordering from Allegro. Without doing that we would easily hit our cap before the year ran out, like we did when DS was on oxygen. I'm also talking with Allegro about ordering DSs feeding bags, since LifeTech is charging us $25/bag, and we use 1-2bags/day!

I think this past year (2006) we spent around $7500 out of pocket for DS. This next year will be worse with the 80/20 limits, and the fact that they only cover 60 therapy visits/year. He does PT/OT/ST weekly which totals 135 sessions/year on average (once we take out cancellations and vacations). His sessions are $170/each - so that's $12,750 not covered by insurance right there. And no, we don't qualify for any support - and since he's over 3, the states 0-3program won't cover it either
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  #11  
January 14th, 2007, 11:05 AM
m.and.a
Guest
Posts: n/a
Quote:
We use LifeTech (local to Chicago area) for DSs enteral equipment. We used to have them for his oxygen needs, then switched to Apria when we needed smaller tanks (below D-tank) for lower flow oxygen, but we kept the suction machine and sat monitor with LifeTech. DS has been off the oxygen for a little over a year now, so we're only using LifeTech. however, I get my formula (nutren jr), syringes, g-tubes and extensions through Allegromedical.com. Their prices are considerabley lower. With Lifetech, we were being charged $8.50 for one 60CC feeding syringe (before we switched to the pump). Through Allegro I was able to order the identical syringe for only 65cents. 5cc syringes were $5.50, I get 100 for $20 now.

We're switching insurance companies in March though, and they'll only cover DME 80%, so we're trying to find out if they'll purchase DSs feeding pump vs. us having to pay the rental cost, because LifeTech is ripping us off there (around $700/mo). Of course it all goes through insurance, but we do have limits, so we've tried to bargain shop where we can - thus my ordering from Allegro. Without doing that we would easily hit our cap before the year ran out, like we did when DS was on oxygen. I'm also talking with Allegro about ordering DSs feeding bags, since LifeTech is charging us $25/bag, and we use 1-2bags/day!

I think this past year (2006) we spent around $7500 out of pocket for DS. This next year will be worse with the 80/20 limits, and the fact that they only cover 60 therapy visits/year. He does PT/OT/ST weekly which totals 135 sessions/year on average (once we take out cancellations and vacations). His sessions are $170/each - so that's $12,750 not covered by insurance right there. And no, we don't qualify for any support - and since he's over 3, the states 0-3program won't cover it either [/b]
Kitty, I don't know alot about your situation, sorry, but I can't believe your son doesn't qualify for medical assistance through medicaid! Since you mention a suction machine, I assume he is trached? I know it is different from state to state, but really! Did you have a social worker in the NICU? Have you ever visited the Trach message boards? Every trached child I've ever heard of is on a "technology waiver" for medicaid. There has to be some way you can get some assistance.

Our problem is not paying for it, but there is such a shortage of therapists. We get therapy 2xs a month, which is okay now because developmentally, she's much like a newborn, but when she gets older, I'll be interested in getting it weekly.

Illinois Specialized Care for Children.

Quote:
Quote:
We use LifeTech (local to Chicago area) for DSs enteral equipment. We used to have them for his oxygen needs, then switched to Apria when we needed smaller tanks (below D-tank) for lower flow oxygen, but we kept the suction machine and sat monitor with LifeTech. DS has been off the oxygen for a little over a year now, so we're only using LifeTech. however, I get my formula (nutren jr), syringes, g-tubes and extensions through Allegromedical.com. Their prices are considerabley lower. With Lifetech, we were being charged $8.50 for one 60CC feeding syringe (before we switched to the pump). Through Allegro I was able to order the identical syringe for only 65cents. 5cc syringes were $5.50, I get 100 for $20 now.

We're switching insurance companies in March though, and they'll only cover DME 80%, so we're trying to find out if they'll purchase DSs feeding pump vs. us having to pay the rental cost, because LifeTech is ripping us off there (around $700/mo). Of course it all goes through insurance, but we do have limits, so we've tried to bargain shop where we can - thus my ordering from Allegro. Without doing that we would easily hit our cap before the year ran out, like we did when DS was on oxygen. I'm also talking with Allegro about ordering DSs feeding bags, since LifeTech is charging us $25/bag, and we use 1-2bags/day!

I think this past year (2006) we spent around $7500 out of pocket for DS. This next year will be worse with the 80/20 limits, and the fact that they only cover 60 therapy visits/year. He does PT/OT/ST weekly which totals 135 sessions/year on average (once we take out cancellations and vacations). His sessions are $170/each - so that's $12,750 not covered by insurance right there. And no, we don't qualify for any support - and since he's over 3, the states 0-3program won't cover it either [/b]
Kitty, I don't know alot about your situation, sorry, but I can't believe your son doesn't qualify for medical assistance through medicaid! Since you mention a suction machine, I assume he is trached? I know it is different from state to state, but really! Did you have a social worker in the NICU? Have you ever visited the Trach message boards? Every trached child I've ever heard of is on a "technology waiver" for medicaid. There has to be some way you can get some assistance.

Our problem is not paying for it, but there is such a shortage of therapists. We get therapy 2xs a month, which is okay now because developmentally, she's much like a newborn, but when she gets older, I'll be interested in getting it weekly.

Illinois Specialized Care for Children.
[/b]

In our case, whatever our insurance doesn't pick up, Medicaid pays for.
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  #12  
January 14th, 2007, 09:06 PM
kittycat's Avatar Platinum Supermommy
Join Date: Jul 2004
Location: Chicago, IL (W Burbs)
Posts: 12,488
My son didn't have a trach, he was on in-home & portable oxygen (nasal canula) until almost his 2nd birthday. The suction machine was necessary because he vomited out of his nose, and also produced thick secretions that could only be removed with a suction catheter (which we no longer use/have need for).

Division of Specialized Care for Children is the most liberal gifted care benefit program in the state. I just spoke with the case worker again in September, I believe. The income requirement for a family of 3 caps around $65K/year (if I'm remembering correctly). (see here for financial guidelines). We live in the chicago area which has considerably higher costs of living compared to anywhere downstate, and with that comes higher pay scales. As such - our income far exceeds the minimum requirement. If we didn't have Kyle on our insurance, we would qualify under the states "All Kids" program. http://www.allkids.com/income.html With that, we would pay $250/mo in premiums, plus up to $5k/year in hospital services. The downside is that we would be subjected to crummy medical care, and several restrictions that we don't currently have in place.

I'm not being difficult over this, but there isn't an avenue that I knowingly haven't explored for resolving these issues. We fight tooth and nail, weekly, with insurance to ensure that Kyle's bills get paid. At one point, we were 1yr past due on $80K worth of medical bills that insurance was supposed to pay, and dragged their feet on. For the past 6mo, they've been pretty good about paying on time - which has been good. But I still have around $16K from the first 1/2 of the year that we're trying to get resolved. It's always something, and since Kyle's birth - we've managed to accumulate nearly $2million in bills - so nothing is ever easy.
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  #13  
January 14th, 2007, 10:36 PM
m.and.a
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Katra,

I'm so sorry for you. I'm just in a state of disbelief that your state isn't more willing to help with the costs of keeping your baby healthy without sacrificing the quality of care you currently have.

But you know, now that I think about it, our pulmonologist did tell us he had some parents of patients get divorced in order to qualify for assitance because paying for it would have been too much of a burden. He also said he's had people move to different areas in order to get on a new scale. It just isn't fair. Things shouldn't be that way.

I've had my dose of grateful today.

Katra,

I'm so sorry for you. I'm just in a state of disbelief that your state isn't more willing to help with the costs of keeping your baby healthy without sacrificing the quality of care you currently have.

But you know, now that I think about it, our pulmonologist did tell us he had some parents of patients get divorced in order to qualify for assitance because paying for it would have been too much of a burden. He also said he's had people move to different areas in order to get on a new scale. It just isn't fair. Things shouldn't be that way.

I've had my dose of grateful today.

And we've gotten some pretty hefty bills in the mail from Drs who don't "second bill" medicaid and/or don't accept United. (this happens a lot) Their loss. I tell them they can either 2nd bill it, or write it off. Their choice.
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  #14  
January 14th, 2007, 11:35 PM
kittycat's Avatar Platinum Supermommy
Join Date: Jul 2004
Location: Chicago, IL (W Burbs)
Posts: 12,488
Quote:
Katra,

I'm so sorry for you. I'm just in a state of disbelief that your state isn't more willing to help with the costs of keeping your baby healthy without sacrificing the quality of care you currently have.

But you know, now that I think about it, our pulmonologist did tell us he had some parents of patients get divorced in order to qualify for assitance because paying for it would have been too much of a burden. He also said he's had people move to different areas in order to get on a new scale. It just isn't fair. Things shouldn't be that way.

I've had my dose of grateful today.[/b]
It's just that things are based solely on income, and no consideration for where you live. Up until now we've been able to afford the overruns - and just accept that it's our burden to contribute more, so that those less fortunate don't have to. However, when I'm facing over $12K in therapy bills for next year, plus other expenses that won't be covered, it gets a little extreme. And quite honestly, someone living in say - Springfield, IL, making $60K/year and qualifying from 100% to at worst paying $40/mo for their services, it's unfair. The cost of living is substantially less in that region. I know because that's where my entire family is from, and where I grew up/first began working. So they in essence live better than us, and we pay a bigger portion out of pocket. But it's just the way the system works.

In states like Michigan & Wisconsin (border states), I know that their programs cover 100%. I believe Michigan is one that state automatically picks up the baby on Medicaid on day 30 in the NICU - to ease the financial burden where insurance falls through. We don't have that option here.
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  #15  
January 15th, 2007, 12:27 PM
m.and.a
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Right, Aleah immediately qualified for Medicaid because she weighed less than 1250 grams at birth, but there is a similar qualification for babies who are in the hospital for 30 days under residential care or something. From the hospital, they they are rotated into the "tech waiver" program.
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