My trachs aren't being approved!!!

Christamae · #1 05-22-2007, 08:24 PM

I am getting into a bit of a crisis. Insurance has decided that I only need to change my trach once a month. I need 2 trachs.

I have tried to reuse trachs but every time I did I got pneumonia. We followed the sterilization procedure perfectly.

Even if I could sterilize it, there is the issue of the cuff that 'dies.' It won't stay inflated for more than 45 minutes. I cannot using a speaking valve and always need the cuff up on the vent because of a very enlarged stoma and deviated trachea. The vent doesn't give me the support I need without the cuff.

I am getting worried. This trach is making me cough and gag and increasing secretions and needs changed. This is a sign of the yeast that covers my trach after two weeks. I only have 2 trachs left-1 and my emergency 1. My trach is a special order Bivona (pediatric extended length with stoma seal)

I am really worried. I don't even have a medical caseworker! I need to change this trach...but what if I run out!!

Insurance is "reviewing" my appeal...

Is there anything I can do?!

Christamae

Mom2TwinsPlus1 · #2 05-22-2007, 09:19 PM

Not sure what to tell you other than that really stinks! How about going to the ER and telling them that you can't breath right and need to change your trach but don't have any to change it with. They might help you,(if they have your special order ones) and the insurance will soon realize its cheaper to send you the trachs than to have you run to the ER all the time

drct1245 · #3 05-22-2007, 11:15 PM

UUUUHHHGGG!!! How awful - I am so sorry. I would call your pulm or ENT and tell them. By doing so, they can help you fight. We had a much lesser situation, but our pulm got on the phone and it was resolved w/in hours. Is there a local advocacy group that you can talk to?? And if you do have an issue before then, going to the ER is your best bet where they will have a trach and know how to treat you.

Christamae · #4 05-23-2007, 06:08 PM

The ER can't help me. A regular trach will not secure my airway.

I have to have the stoma seal...

Ann · #5 05-23-2007, 06:24 PM

Sounds to me as if your doctor needs to step up to the plate and make sure you get what you need. It's unacceptable what you are having to deal with. If all else fails, there is always the media. Good luck and I'm sorry you are having to deal with this.

Isaac'sMomandDad · #6 05-23-2007, 06:33 PM

Oh, I'm sorry this is happening!!

Definitely hold onto one or two of the "old ones" as emergencies, after all a dirty trach is better than no trach if you get stuck, but I would have your doc write a letter of medical necessity, documenting the multiple times you've had pneumonia from re-using a trach, hopefully that will help with your appeal. Can you pay for some out of pocket while you are waiting for the appeal? Do you have medicaid as well? Sounds like you should have a case manager thru your insurance, talk to them as well...

Good luck!!

Lara

Whitney · #7 05-23-2007, 07:09 PM

Do you still have Aetna? Ask for an urgent appeal and they must give you an answer within 48 hours (or something like that). If not, ask your insurance company what appeal process they have in place for urgent situations and get your doctor involved in that appeal (have them call/write letters). They can't leave you hanging for too long. Good luck and I hope you get that resolved.