Friday, July 24, 2009

Feeling so sad and so mad!

We have just become aware of a drastic change to Branden's health insurance coverage which will go into effect on September 1st. It will affect all non-contracted Dr.'s, lab's, etc. I'm so SAD because the coverage was (in my opinion) already so low and now it's going to be ridiculously low and I am so MAD because they have opted to make this change mid-plan year. I certainly understand that IF you are lucky enough to be healthy than staying in-network for services is pretty easy or at least doable, BUT if you have a medical condition like our daughter does (or will have as soon as she arrives) than staying within network isn't always an option. We have already met with her first non-network Dr. which she will be seeing on a regular basis and will be performing two VERY EXPENSIVE surgeries. I know that he will be the first of many non-contracted specialist and I am just so very overwhelmed by what this new change is going to mean for our family. I am seriously concerned that the baby's medical expenses could bankrupt our family. If you have ever had a real and imminent financial concern than you know what I am talking about. I am SO stressed out over this and poor Branden just doesn't know what to say or do. I am truly a wreck right now and I know that I need to stay calm to keep my blood pressure down and to help keep this baby in a few weeks longer. I am 35 weeks on Saturday. I am so thankful that she will be arriving before September 1st and can only pray that she will not have any additional surgeries after that date. Shut revision are extremely common and I just pray that she will not need one, not only because it's super scary but also because I have n idea how we will be able to pay for it. I know that I should be grateful that we have insurance albeit some months it barely feels like it but I don't feel grateful right now. I feel sad, mad and really scared! I realize that companies do what they believe will be "best Financially" for the whole organization but when you are so drastically affected by a change it's REALLY hard to feel anything but anger and resentment toward them - regardless of how gently they tried to present the information to us.

Check out this example that was provided to us:

Example is for one individual only.

Current Non-Network Plan
Non-Network doctor charges $40,000
Insurance pays 70% $28,000
Balance Due $12,000

Employee responsible for 30% up to $4,000 maximum out-of-pocket amount $4,000
Insurance now pays additional balance at 100% due to out-of-pocket maximum $8,000

Total Insurance Pays $36,000
Total Employee Pays $4,000


New Non-Network Plan Effective September 1, 2009
Non-Network doctor charges $40,000

Adjusted amount that insurance will accept (In-Network ACR Amount) $30,000
Insurance pays 70% of In-Network ACR amount $21,000
Balance of ACR Amount Due $9,000

Employee responsible for 30% of ACR amount up to $4,000 maximum out-of-pocket amount $4,000
Insurance now pays additional balance of ACR at 100% due to out-of-pocket maximum $5,000

Plus employee is responsible for total amount over ACR ($40,000 - $30,000) $10,000

Total Insurance Pays $26,000
Total Employee Pays (Amount over ACR Plus Out-Of-Pocket) $14,000

So in this scenario presented above - under the current plan, on a $40k bill we would have to pay $4,000 (which would be out out-of-pocket maximum). This is what we had been planning for ever since we found out about the baby's medical condition and the surgeries she will need.

But under the new plan effective 9-1-09 for that same $40k bill we would have to pay $14,000. However, keep in mind that $10k of that does not apply to anything and if she was to have another $40k bill (which is VERY likely if she has another surgery) we would then need to pay ANOTHER $10k and this could go on as many times as billed for that calendar year. Then come January 1, 2010 it would all start up again and if she had another expensive "issue" it would be ANOTHER $14k because we would need to pay that $4,000 out of pocket maximum again.

I have to tell you that the term "Out-Of-Pocket Maximum" seems so stupid now considering IT IS NOT THE MAXIMUM we would pay - it is only the beginning of what we will be expected to pay. I'm sorry, I just think this is complete bullshit and the more I write the more pissed off I get. I think it is horrible that hard working families can be put in a situation like this when we have done nothing wrong. We seriously live such a modest life in an effort to have me stay home and be the primary care giver to our children - we don't have cable, get the newspaper, we RARELY ever go out to eat, we don't buy unnecessary things - we have tried to do it right so that we can provide for our children now and in the future and then something like this happens. No one plans to have an ill child and I think it is seriously unfair that this situation is going to so drastically change our financial future and the even shittier thing is there is really nothing we can do.

Just Hanging out!

On Thursday night Branden had some work to do in the bedroom so the boys and I decided to hang out in the front yard after dinner. They were riding their bikes and pulling their wagon and just being silly. It had been a super long day of stress (due to the health insurance stuff) and It just felt good to sit out front and be with the boys and not think about anything but them.

By the way our WONDERFULLY YUMMY dinner was brought to us by our very good friend Cheryl. Thank you so much for always being there for me and my family. We love you and are so grateful for your friendship. Dinner was really great and couldn't have come on a better day!

Tuesday, July 21, 2009

Costume Day at Preschool

Today was costume day at Jack's preschool. He was really debating on which costume he wanted to wear but finally settled on his Knight / Prince costume. He was so cute and proud of his outfit when posing for this picture. He wore it the whole day at school.

Auntie Frances and Uncle Michael

Stopped by on Monday afternoon for a short visit before they headed out on vacation. The boys really enjoyed seeing them and hope to see them again soon.

Get together with old friends

On Monday morning the boys and I met up with Laura and her girls and Sherisse and Bradley for a little playdate. We haven't all been together for a play date in a while so this was extra special. As the kids have gotten older, their schedules have gotten busier, Laura and I have added to our families and Sherisse and Bradley have moved out of the local area it's become harder to get together like we did in the early day's of motherhood.

Laura, Sherisse and I met in a Baby Dance class (2005) when the kids were just about 6 weeks old. We became instant friends and spent most of the kids first year together on stroller walks, park and beach playdates and just experiencing the world with our new little ones. On Monday, It was amazing to watch the kids play together now and to see their younger sibling bigger than these three were when they met just 4 short years ago. Most of my pictures from that first year are inaccessible right now (due to the bedroom project) but I will add them (as a cute comparison) once I can get to those disks.

The kids enjoyed playing dress up inside for a while then we all headed outside for a bit of splashing in the pool. It was a very nice morning and we look forward to doing it again soon. Thank you again Laura for your hospitality!

It truly doesn't get much cuter than this!
They stopped chasing each other to pose for this adorable picture.

PS - this was costume change #20 or so for Jack. He LOVES all of Finn's dress up clothes.

After swimming, the kids enjoyed some yummy peach muffins (made by Laura), orange wedges, edamame, organic crackers and of course some pirate booty!

My Three Kings!

On Sunday morning the boys decided to make their daddy Kings crowns to thank him for all of the hard work he has been doing at the office and here at the house. Branden loved them very much! Benjamin decided to keep the one he made for his dad, which was fine since Branden can only were one at a time.

They put on their crowns and were being SUPER SILLY!!

I apologize for the craziness of these videos, but the Summers boys were crazy tonight!
I like to post videos so that Branden's mother who lives in Oregon can see her son and grand son's live in action.

Kathy - please let us know if you see these videos. Feel free to leave a comment or send an e-mail sometime - we miss you!

Here's Branden's version of a comedy show with his boys.
I don't think they are ready to take this one on the road yet.

Fun in the Sun with the Beard's

at Auntie Shannon's House

We were really thankful when Shannon invited us over to play. It was going to be another HOT Saturday and I needed to get the kids out of the house so that Branden could continue working on the house projects. The kids played nicely inside for about an hour then we moved outside for a bit of FUN IN THE SUN!!

Shannon was SO GREAT with the kids. My boys were a bit apprehensive at first until Auntie Shannon offered to slide them down the slip in slide. Boy did she get her work out for the day. Their happy faces and the GREAT naps we got later that day say it all.

Thank you Shannon for your hospitality and your help with the boys - we had a great time!

The joys of brotherhood!
Just check out those HAPPY, SMILING faces!!
The kids got SUPER wet and were having a blast!
After our fun outside the kids decided to do a little break dancing.

The kids really had a GREAT time playing together!

Monday, July 20, 2009

34 week pregnant picture

34 weeks pregnant with our little girl!

My mom took this picture since I have been a bit camera shy this pregnancy.

A week in review

Monday, July 13th - Friday, July 17th

Seems like the week went by SO fast and now we are half way through the next week that I better do an entry about it or I will soon forget what we did and the fun we had.

MONDAY: Fun with Grammy. Does that look like fun or what???


Well, once again I had a failed attempt to take the boys to the free movies at the Towne Center. Because Ben is just so wiggly I don't feel comfortable taking the boys on my own and I haven't been able to secure any help on Wednesday. It just doesn't seem unfair to Jack to have to leave in the middle or whenever Ben starts acting like Ben. So, I did what any Mom who is dying of heat exhaustion in her house with two small children does - she takes the kids to the library for story time!

Luckily, it wasn't just story time it was a fun music performance but a man and a women. She sang and play different hand held instruments and the man sang and played the guitar. The kids LOVED it and it was a full hour long of singing, dancing in the air conditioned library - so I LOVED it to. Of course, I didn't bring the camera with me. I got a few shots on my phone, but they are pretty bad. I might add them if I find a moment. I was happy that our morning was salvaged and the boys had fun.

Later that night we went to CONCERT IN THE PARK. It was super fun this week! The kids had a blast, the music was upbeat and fun and the food was GREAT! We had a Mexican themed pot luck and I stuffed myself. What more can you ask for - good friends and good food!

Jack with the "Andrew Sisters"

Benjamin, Sammy, Emily and Jack

Having fun with Miss Lisa and the girls!

We had a very nice and relaxing (so great for me) morning at Mary and Matthew Dau's house. The kids played super well and Mary and I were able to actually visit much more than we ever have before. Mary thank you for your hospitality!
It was a good week. I am so thankful for the help I have received with the boys from my Mom and my friends. Being told to take it easy is really difficult when you have two little boys so I am just so grateful for the babysitting help and the dancing and play dates to help keep my boys occupied and happy! I have no idea what I would do without you guys in my life.

Wednesday, July 15, 2009

Why it pays to take a nap

On Sunday, July 12th Jack took a good nap so we allowed him to stay up a bit later than normal and help us with our painting project. He thought it was pretty cool that we were just putting different colors up on the walls to see what we liked. He asked if we could do his room next. Uh... NO!
Jack really enjoyed putting paint on our walls

Benjamin, on the other had did NOT take a good nap. He decided to "redecorate" his room while he was supposed to be sleeping. This unfortunately has become a bit of a regular habit during nap time that does NOT make mommy and daddy happy at all. Needless to say Benjamin went to bed early and missed out on all of the painting fun.

Baby Shower Blessings

On Saturday, July 11th my good friends Cheryl, Shannon, Becky and Amber threw me baby shower. It was a dessert / drink shower and it was a truly wonderful evening. Many of my close friends and some family gathered to celebrate the upcoming arrival of our baby girl. For those that were unable to attend, you were missed.

Thank you all for the wonderful gifts and for spending your Saturday evening celebrating me and our baby girl. We are so excited for her arrival and to put her in all of the ADORABLE clothes we received.

There were so many great treats to chose from.
Of course, I didn't chose - I tasted them all.

The tables were beautifully set to create a relaxing and inviting atmosphere.

Everyone seemed to really enjoy themselves,
which makes me SO happy! I had a wonderful time!

We feel so blessed by all of the amazing gifts we received. Thank you all so much!

Cheryl, Me, Becky and Shannon at the end of the night.
Amber, we missed you!