Friday, September 7, 2018

Sophie B. Vs The Great American Healthcare System, Part 1,000,000: ROUND 2

Article 1

Please See Round One Timeline HERE Before Proceeding and for Explication of Article 1, above. Note that I can get you a copy of the Explanation of Benefits, regarding this decision, AT NO COST, thanks to the Insurance Company, so email me if you'd like one.

Big Girl Panties ON?
Loins Girded?


September 4-6, 2018

Mother/Conservator makes repeated calls to Neurologist and Neurology Office to check on progress of Plaintiff’s appeal to get necessary IVIG treatment for ESES. Neurologist reports that Blue Shield of CA does not respond to repeated attempts to call. Plaintiff appears further weakened and distressed, drooling, difficulty swallowing and drinking. Mother/Conservator expresses distress and frustration, and Neurologist responds appropriately, assuring her that “we’re going to get this done.”

September 7, 2018
10:30 am
Mother/Conservator makes morning call to Neurologist for update on Plaintiff’s appeal to get treatment for ESES. Note that TWO WEEKS have passed since diagnosis was confirmed and order for treatment was made. Neurologist states that if his efforts to appeal to Blue Cross of CA are fruitless, he will admit Plaintiff via emergent care for hospital administration of infusions. (Mother/Conservator states that her own condition is extremely stressed out. She actually posted the following picture (Article 2) on her social media page but assures all parties involved that her rage as depicted in picture with weapon in hand is metaphorical.

Article 2

10:43 am
In the middle of Neurologist's statement that he will admit Plaintiff to emergent care for hospital administration of medication if he is unable to get through to Blue Cross of CA by end of day, Mother/Conservator receives a text message. Because of her finger dexterity (considered extremely high as measured by an expensive personality and skills test administered in the last century by a famous company) and multi-tasking skills, coupled with afore-mentioned extreme stress (which renders Mother/Conservator more like larger mammalian creatures on guard and extremely alert faced with threats to offspring -- think bear, moose, etc.), Mother/Conservator switches over to text messages and reads this (Article 3):

Article 3 with professional names redacted with quasi-religious symbols that were inserted by Mother/Conservator, despite her lack of religious faith

Mother/Conservator shrieks news of approval to Neurologist who is speechless, given that he has been unsuccessful in reaching Insurance Company. Mother/Conservator wonders aloud what the hell has happened here? Her tiny little mother mind™ is busy, busy wondering whether this weird and random event is somehow related to her blog post from the previous day and the many thousands of "hits" it has received, but her body, always many, many steps behind the tiny little mother mind™, feels a rush of adrenaline and she tells The Neurologist that she will hang up and call the Nursing Agency to make the appointments for Plaintiff to receive treatments. Because her body is in a riot, and her tiny little mother mind™ is busy, busy, Mother/Conservator does not remember how she hangs up from Neurologist but believes he asked her to let me know when Plaintiff gets her schedule of infusions.

10:45 am

Mother/Conservator calls Nurse at Agency who has texted her the GOOD NEWS (the lettering of which the tiny little mother mind™believes to be rather Trumpian and is amused by this and then quickly horrified because part of the extreme stress is due to the constant worry about the healthcare system and the steady erosion of what little benefits the Affordable Care Act has conferred upon Plaintiff and family and hundreds of families that Mother/Conservator knows, benefits which are under attack even as this is typed), and Nurse at Agency tells Mother/Conservator that just that morning, the Agency received a letter from Blue Shield of California with a reversal of former denial. See Article 4.

Article 4

Both Mother/Conservator and Nurse at Agency laugh incredulously at this seemingly miraculous turn of events and then move forward and set up Plaintiff's schedule for infusions immediately.


Sophie B vs. The Great American Healthcare System

WINNER: Sophie B.
LOSER: The Great American Healthcare System and Mother/Conservator's Relative Sanity (See Article 5)

Article 5


  1. You are a wonder. Fingers crossed Sophie feels much, much better very soon. XOXO (PS - can you send them those panties now?)

  2. Once again you have taken the most hellacious bale of hay imaginable and spun pure gold of it and in the process you have, ONCE AGAIN, saved your child's very life.
    I hate to think of all of the blood on that spindle.

  3. Well, holy shit and smack me fucking thrilled. And here I was going to be happy at you receiving the Explanation of Benefits free of charge.

  4. I'm glad to hear of the approval, but this is all so freakin surreal. Who lives like this?! Oh, right.

    Sending love and strength.

  5. Heartening to know that Sophie will soon be feeling some relief. Article 5 speaks powerfully and eloquently of your experience.

  6. So Glad to hear it, Elizabeth. Here's hoping Sophie is feeling better soon. x0x0 N2

  7. Oh how I feel your pain Elizabeth! I stand with you in solidarity. You are my advocate inspiration. Thank you for describing so brilliantly, the truly absurd tactics insurance companies use to thwart the use of expensive medications and therapies to its most vulnerable (and most expensively served populace?) As usual, we have experienced similar stories. MassHealth dropped Weston from coverage (who is now 19) because he makes too much money? Say what? He made less than $1,000 for the entire year. It took me all of the July 4th week, speaking to numerous MassHealth employees, (at least 6) all of whom told me a different reason for why he was dropped. Each time I called I waited at least 45 minutes on hold before someone even picked up the phone....! Through luck of the telephone roulette draw, I finally found the right MassHealth employee. familiar with the law, who at last, re-instated him.....after a week with no coverage.

  8. I am so very relieve to hear of this incredible turn of events and that Sophie will now be receiving her Treatments! Whew! My Son is presently in Hospital and receiving much needed Treatments despite having no Health Care or steady Employment, he had neglected to go in spite of his seizure activity increasing for fear they would reject him with no Insurance. We will be petitioning the State for Services/Coverage... and the Hospital said they also have some programs to assist due to the extreme nature of his decline... it just worries me to death, you have to appear almost ready to die before present Help is extended! I'm Celebrating with you and Sophie!!! The Heavyweight Belt goes to you this Day and I rejoice about that!



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