January 22,2014
Surgery Date: January 31, 2014
Being in the "home stretch" before my PAO surgery (Periacetabular Osteotomy) has been very hectic. I have been doing my best to tie up any and all loose ends such as that dental cleanings, fixing that cracked filling, and getting my hair cut and highlighted as close to surgery as possible so that the regrowth won't look too bad while I am recovering. After coming home from one of my longer days of work and doing these activities I braved the snowy driveway and the negative wind chill to get the mail. Since it was a Wednesday we usually just get the normal supermarket advertisements, coupon flyers, and the "PennySaver". A light mail day. Today, I see a rather large envelope from my health insurance carrier. I trudge up the driveway, enter through my garage, take off my boots and before I remove my coat I open the envelope.
It was a copy of a letter sent to my surgeon with regard to my surgery date and personal information. Below it were the words that NO ONE wants to read: DENIED SERVICE(s) or SUPPLIES: Inpatient Hospital Surgical.
WHAT?????
After my initial panic attack I decided to read the letter further. To my subsequent dismay it stated that Medical Necessity and Appropriateness is required. No benefits will be provided unless it is determined that the service or supply is MEDICALLY NECESSARY & APPROPRIATE. It also stated that they did not have all of the INFORMATION REQUIRED.
YOU HAVE GOT TO BE KIDDING ME??
I'm sorry, but what were all of those visits to the other specialists? What were the preliminary visits to my current surgeon? What were those x-rays and MRI(s) in order for my surgeon to evaluate my hip? What about the MRI Arthragram with contrast? The results of that were conclusive that I definitely had anterior, posterior labral tears with degeneration. I, even as an accountant would probably assert that is a medically NECESSARY condition that needs attention, no? Let alone the anatomy issue that happens to be abnormal. I can assure anyone that it was not elective, nor was it for "funsies".
I have also undergone a battery of pre-operative testing, a full physical, and have been wearing a pretty red bracelet for almost a month.
Well, taking a breath and reading on I decide to call a very good friend who has worked for both an Insurance Carrier and an Orthopedic Group. She said not to worry and that with newer procedures it is usually a person behind a desk who was unable to find the proper medical billing code to satisfy the authorization. She also said that my surgeon would fight for me and for my surgery. Surgeons don't decide to do surgeries like these because they couldn't get a hair appointment that day (her words). I began to feel a little less anxious. However, what bothered me the most was that it was after hours, and it was out of my control. I really had to put my trust in to the hands of someone else to fight for me and to fight for my best interest. I know I have every confidence in the abilities of my surgeon to take care of me in the operating room and afterwards. But, my anxieties were with how good is this guy on the phone? Is he used to doing this? Will he make the call himself? is he required to make the call or do they have someone else do their calls?
January 23,2014
AWAKE @ 4 AM! A full hour before I usually get up during the week. Hello Anxiety! I know that I am going to call my surgeon's office as soon as they open at 8am. How lovely we are again in the midst of another "polar vortex" and it is starting to snow. I am doing my best today. I am staying positive, I have my NutriBullet shake for breakfast and put on my many layers of clothing and still manage to make it to my regular scheduled bus.
Going through the motions at work until 8:00. I ended up having to leave a voice mail for the surgeon's nurse and for his administrative assistant. I received a reassuring call back about 90 minutes later. She called me from another office. She confirmed that she did see the same letter I had received and was already on the case. WHEW! She said not to panic and that she had things in motion for the surgeon to have a peer to peer call so that whatever misunderstanding could be cleared up between two actual DOCTORS. She said that she would call me by the end of the day.
Unfortunately she said that the insurance carriers like to play these little "games". They want to really see how real the claims are and if they can find out why surgeons are choosing certain avenues of treatment over others. UMMMM-Maybe because they are surgeons, doctors, and more educated and are treating the patients for their individual cases and not as a list of billing codes?? Why PAO and not a hip replacement? Because I am too young and too active. I would actually WEAR OUT hip replacements at this point in my life. I will probably get them-but not for a very long time. The surgery that I am slated to get is hip preservation. It utilizes my native hip to correct and rebuild what is missing (This will be a later post)
Going on with my day, while still anxious, I am feeling better and more confident that things will be okay and work out. I feel that I am in good hands. I carry my phone with me everywhere and even have the ringer on. The call finally comes in while I am riding home on the good old P76 next to my bus friends.
"Hello Jennifer, This is Myrna at Dr.S's office-Everything is okay, he had the conversation and I have the authorization number for your surgery"
Even though this was probably a common practice for the Orthopedic Practice to deal with, it was very jarring and upsetting to get a copy of a letter regarding a surgery that had been denied. Especially when it was less than a week away. because it is about me, I received a copy of the letter. I wish that I could have been spared this day of anxiety. But, if I had, I wouldn't have been able to see how good my doctors are at being patient advocates. I wouldn't have seen how diligent Myrna was and how on the ball she already was when she returned my call. I would not have been able to see that there are teams of people working very hard for a very long time in preparation for a day that is only a week away. I am very glad that insurance companies are not allowed to call the shots. It is really scary to think of the debates going on about healthcare reform.
It isn't about Insurance policies-it is about people. Illness doesn't know your tax bracket. It doesn't care what your benefits package does or doesn't cover. We need our doctors and other health professionals to be our advocates to make sure that PEOPLE get the CARE they need and that they deserve.
~DRIVE SLOW~
Tomorrow is Friday-After that is only four more work days until surgery. CRUNCH TIME. I will be posting every day.
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