Murri Mayhem: September 2009

Having worked in the medical field with many different kinds of doctors, I feel I can say this about those doctors who have served their time with actual patients & feel they can then move on to an higher office only to dictate a standardized program of what will & will not be covered. They basically are taking their experience with those actual patients & assuming the rest of the free world will have those exact same symptoms & problems. They figure they have treated them already, so the rest of us can be treated the EXACT SAME WAY!

Holy crow! I am actually "blogging!" It's kind of my way of venting I guess, but whatever. ANYWAY, I am so frustrated with my insurance company right now & it has taken me 2 weeks to have a minute to think, as my kids started school last week & I have already put in 17 volunteer hours in 9 days, not to mention finally found a pre-school that would take my son! I decided to make the time today to do more research on what my son has, velopharyngeal incompetence, or VPI, since we are appealing the "white coat's" decision to deny coverage. Our pediatrician is going to do a peer-to-peer review with the "white coat" but no guarantee what will happen there. While we wait we continue current therapy & feed him from his 10-item diet!

Since so many people have asked what VPI is, I thought I would post it. Beware, there are tons of medical mumbo jumbo that you might need to take a class for, but hey, some of you asked! "Velopharyngeal incompetence is failure of apposition of the soft palate against the pharyngeal wall or lateral walls of the pharynx, resulting in excape of air during phonation leading to nasal speech. It may occur as a primary lesion or be secondary to cleft palate lesions pre or post repair. The child is examined by fluoroscopy while phonating prepractized speech sounds, in both the sagittal and coronal planes." I also found a great link that describes it in a little more detail: http://www.cincinnatichildrens.org/svc/alpha/v/vpi/about/vpi.htm

Basically, his palate doesn't close all the way therefore, air escapes through his nose causing hypernasality. In order to avoid surgery (which insurance is totally willing to cover, no problem!) he can have additional speech therapy. Insurance says they cover speech therapy but it's diagnostic specific, although they deny every single ICD9 code I have given them! No wonder there is insurance fraud! Yeah, I can use a different code, but he doesn't have that problem! Stupid white coats.