When Policy Trumps People

"Insurance has not approved the surgery."

"What does that mean?" I couldn't believe what I was hearing. We were just two days from the surgery, just one away from being admitted into the hospital.

"We will have to postpone the surgery until we can get the approval."

The week leading up to that phone call was long and stressful. Our days were spent fluctuating between a calm confidence and stressful doubt. We were so close to being on the other side of the surgery, and now we had to start over. This time it would be harder because now we were going to have to fight the insurance company.

About 1 month old

The insurance company claims that Caleb isn't sick enough for the transplant. According to their policy, a transplant is only approved when the patient is in liver failure and/or all other medical options have been exhausted. Since Caleb can remain relatively healthy on his current medications and a strict diet, he did not qualify for the transplant. Basically, we are being punished because we have taken care of him.

Since we got the news of the denial, we have been in the process of appealing it. We were told that we would have to appeal and have Caleb's case be under peer review, where it would be denied again. Then we could appeal a second time and actually work with the part of the insurance company that can change policy. Yes, we still had to follow the protocol despite a guaranteed denial for the second appeal.

Last week, we finally got the official denial for the first appeal. We are now working to appeal it for a second time. The doctors are confident that the surgery will be approved. We are hoping for an answer by week's end, but hoping and getting are two very different things.

Caleb's doctor told us that the debate is not whether or not the surgery is necessary but at what age it should happen. Some doctors believe that he needs to be 12 months old, while others, like his surgeon, liver doctor and pediatrician, believe that he is old enough if the right liver is selected.

The past couple of weeks have been pretty difficult for us, but that is for another blog. Today, I just wanted to keep you guys informed.

Pray that we are able to get this resolved quickly. While complete strangers are debating what is best for our child, we are working to keep Caleb healthy. As they debate his health, we worry over whether or not the Army will let us stay here long enough to get the surgery. As these strangers argue amongst themselves, we pray that we don't lose his donor.

Pray for our son, for his donor and for our calm during this storm.


Psalm 94:19
In the multitude of my anxieties within me, your comforts delight my soul.

Psalm 33:20-22
We wait in hope for the Lord; He is our help and our shield. In Him our hearts rejoice, for we trust in His holy name. May your unfailing love rest upon us, O Lord, even as we put our hope in you.