This Day Brought to You by Bureaucracy

It only took a year and forty thousand secretaries to get us here. How could something so simple involve so much paperwork and so many hours lost on the phone? I have no idea. I just know that Single-Payer health care would have worked a lot better.
It all started when he was born with a cleft lip and palate. They told me then that there would be a bone graft sometime between the ages of 6 and 8. When he went to his yearly cleft clinic visit at age 6, we were told it was time. He just needed to get two teeth extracted, heal a month, then he could get the expander. We were told that in March of 2009. Screw it, here's the break down:

March 2009 - At our yearly Cleft Clinic visit, we're told Aleks needs two teeth extracted before getting a palatal expander to prepare for a bone graft.

March-April 2009 - I spend weeks schlepping all over to coordinate the surgery to have teeth extracted and replace his ear tubes. We have to wait on pre-authorization from the insurance company and the people who schedule surgeries are at a loss as to how to then schedule a surgery while we wait. I fix this problem for them by having them schedule it for six weeks in advance. This works. Apparently they need to hire me.

May 2009 - Aleks has surgery to extract the two teeth decaying in the cleft scar in his mouth.

June 2009 - I call the orthodontist the plastic surgeon recommended we go to. Turns out he only comes in once a month because he lives in Canada. Pediatric dentist assures me this will not do. I request other recommended orthodontists only to discover none will take our insurance. No alternative is suggested.

I call a case-worker from our insurance company who helps me find a dentist practicing orthodontics to do the expander. Pediatric dentist calls to make sure he has adequate training and background. He approves (dentist has 30 years experience working with cleft/craniofacial clinics).

September 2009 - We finally get to see the new dentist practicing orthodontics. He says he'll do it under our insurance, but needs the records from the Clinic. Records take several phone calls and weeks, eventually they make it. Then it's a matter of him reading them. Then there's no order for an expander. The dentist's office says they'll handle it, but never seem to.

Eventually I call and get a new order dictated and faxed over. This takes us to the new year.

February 4, 2010 - We finally go to the dentist again to have molds of Aleks' teeth made. The secretary tells me it will take two weeks to have the appliance made and that she'll call me when it's in.

March 2010 - I call because I haven't heard. She says the lab says it won't be ready until at least March 25th.

March 18, 2010 - Aleks' yearly visit to the Cleft Clinic includes me lecturing the plastic surgeon and an administrator at the hospital about their lack of support in finding an orthodontist who can actually treat my son and not just look in his mouth at the Cleft Clinic once a year.

April 2010 - I still haven't heard back from the dentist's office about the expander. I call back. She says she still doesn't have the appliance, but that she'll figure out what's happening and call me back in 20 minutes. A week and a half goes by.

I call again to find out what the hell happened. I'm informed that the lab estimate was more than the insurance will pay and that the dentist is therefor dropping us and sending us to the local dental school instead. This is on a Friday late afternoon - I drive to the office and pick up Aleks' Clinic records directly.

I call the Clinic. Some secretary is filling in for the other secretaries, but she tells me that most of the other cleft patients have supplemental insurance through the Bureau of Children with Medical Handicaps (BCMH - she only knows the acronym, however, and not what it stands for so my mother tells me when I call nearly crying). If BCMH was ever mentioned to me, I have no recollection of it, no paperwork, no application, and it was never impressed upon me that it might become necessary.

I call a community liaison at the hospital to bitch. She gets me a phone number of a social worker there who is the wrong social worker who gives me another social worker's number who is not in and I leave a voice mail for. I also leave a message for the case worker at the insurance company who originally found me the asshat who dropped us.

Monday morning, I called BCMH. They tell me that I can't even apply directly and that a BCMH affiliated physician has to apply for me. Turns out the plastic surgeon is a BCMH affiliated physician, but again, if he ever mentioned it, he didn't give me an application or start the process or anything, so fat lot of good it did. I am assured, however, that my son will automatically qualify due to his being on Medicaid. The application takes 16-22 weeks to process, but covers 60 days retroactively from the date of application.

So I call the plastic surgeon's office again and talk to yet another secretary to express my intense dismay at not having a care provider for the expander. This one seems to listen to me. She sends an email to all the other secretaries in his office and tells me that if we don't hear back by the next day, the next step will be to contact the hospital Ombudsman also known as They Who Get Shit Done.

The next day, someone calls. She calls me four or five times, asking all sorts of questions. She has me call the orthodontist working with the Cleft Clinic because his association with it means that he has to take our Medicaid HMO. I call his office. They do not. They do, however, have a couple of BCMH patients, but apparently even that is pretty complicated for them. It is not encouraging. I call the other lady back again. She assures me that the plastic surgeon's varying secretaries - utterly useless before - will make sure the orthodontist's financial people know what they're doing and how to use the correct codes so they will accept our BCMH. Finally, she assures me the BCMH application will be underway ASAP. I am encouraged to go ahead and make an appointment with the orthodontist. I do.

June 1, 2010 - We have our first appointment with the orthodontist. They take a bunch of x-rays and photographs and count and assess Aleks' teeth and we're there forever. They put separators in Aleks' teeth to prep him for the expander rings. They smile and give us ice cream and even accept that our BCMH application will come through to pay them eventually.

June 4, 2010 - We go back again to have a mold done of Aleks' teeth.

Today, June 9, 2010 - Aleks gets his expander. Done. Easy. Only took a year. And now Aleks finally has his expander. He can neither talk nor swallow very well, but he will eat ice cream and make very loud sucking sounds to prevent food from getting stuck in it. We're assured there's a learning curve on the swallowing and talking. Almost time for another dose of ibuprofen to ease the ache.

In six weeks, he gets headgear to stretch his underbite. He wears that for four months and the expander for 8 or 9. Then he gets part of his hip shaved off and stuck in the roof of his mouth to keep the teeth from collapsing back in. My poor baby.