Thursday, September 17, 2015

Surgery Update WTF

     Yeah so I would love to say I just haven't been posting everything because of my recovery, but that just isn't the case.  So when I last posted it was the start to the Labor Day weekend and I was told by the doctor's nurse that he would contact the insurance company Tuesday and she would call me with an update.  Tuesday came and by late afternoon I hadn't heard anything, so I called them.  After being put on hold for several minutes I was informed that the doctor would be calling tomorrow, the day before the surgery, because he wasn't in the office today.   I thought, "Really?!, but ok."

     The next morning I wake up and anxiously awaited the verdict.  I received the call around 10ish letting me know that the surgery has been canceled.  The nurse stated that the insurance company would not budge on their position that this surgery is exploratory and that with a procedure such as this requires medication, rest and alternative treatments before they will authorize the surgery.

     Of course it goes without saying, but I will anyway, that I was SUPER PISSED and extremely disappointed.  I proceeded to call my insurance company and vent my frustrations, which got me passed along from one person to another who could supposedly help me, I was finally transferred to a voicemail where I left all my info while thinking there is no way in hell anyone will call me back.  Little did I know that I would get a call back several hours later.  The conversation with the nurse for their medical staff, basically went back and forth just like a tennis match.  I could tell she was getting a pissed off with me because I wouldn't give in and kept on till after 20 plus minutes she finally said what the real reason they denied it.  Basically, Anthem has different procedures that no mater what have a list of things that must be tried before a surgical option will be explored.  Them denying my surgery wasn't because their doctor disagreed with my doctor its because of their policy and my surgery fit this bullshit policy.  So instead of doing what is medically necessary their policy has me jumping through hoops till they say otherwise.  

     After the conversation with the insurance company I called the nurse at my doctor's office to let them know what the ins company had to say, and that is when things start to get a little "funny" for me.  The nurse says that she is calling in a prescription to my pharmacy and will be mailing me a prescription for physical therapy that she will mail me.  I hang up and call it a day and instead of going back to work for the week, I decided to use the rest of the week to spend time with my wife, my family who were in town and for myself to just relax and decompress.  Friday my wife surprised me with a tattoo appointment because she wanted something to go right for me this week.  Only those that have tattoos and really enjoy the act of getting one just as much as the artwork involved know what I am talking about when I say that it was just the thing I needed to relieve some stress.  Wow did I feel so much better after we were all done. 

     So, fast forward a few days and this is where my head is at.

     I am beginning to think my doctor and his staff don't know what the fuck they are doing.  Sunday, a full four days after the nurse stated she was calling in my script, I stopped by the pharmacy and to my surprise there was no prescription waiting for me.  I thought to myself, maybe she meant she was mailing the script along with the PT prescription.  When Wednesday came and still nothing I decided to see just what the hell is going on.  I had to return the recovery medical supplies that I had received prior to my surgery that I wrote about here.  

     The medical supply company is located in the same office as the doctor and since I still haven't received my prescriptions for my meds and PT I thought I would kill two birds with one stone while I was there.  When I asked them about the medication and PT no one seemed to know what I was talking about.  The nurse I spoke with asked me to sit and wait till the doctor got out of a consultation so she could talk with him.  I was close enough to them that I was able to listen in on some of their conversation and when she asked him about the medication he said I don't care whatever we usually give.  After the doctor walked away, she called me back over to get everything taken care of.  After the nurse asked me what pharmacy I wanted the meds called into, she still ended up calling them into the wrong place.  I mean come on Dean, cut her a little slack, Right Aid and Walgreen's sounds exactly a like.  But I digress.  Oh, and the nurse on the phone from last week, the one that was taking care of all this, told me the insurance company needed me to have PT for 3 months and Wednesday the doctor only prescribed 6 weeks of physical therapy. WTF!  Doesn't anyone know what is going on?

     After today, I am on the fence about seeking a 2nd opinion and wondering if some of what the insurance company was blaming on the doctor was, in fact, true.

Sunday, September 6, 2015

Stick To Your Word, That's All I Ask


     So Friday, on my personal Facebook account I posted a single line and a photo that pretty much says it all to how I was feeling.  I am a simple person that has his own faults and understands simple mistakes are made in life, but as a person who has spent the better part of his working life in the retail customer service industry, I know how important your word  is to a customer.  You break that word and not only do you lose a customer, but your credibility is lost with future customers as well.  When other companies do this to me, it pisses me off!  Why a person or, a company in this case, can't or won't at least do the fucking minimum requirements of a job that would provide basic level quality customer service I'll never know.  It all comes down to the fact that if you say your going to do something than fucking do it.  Don't say you will and then weeks later take it back and wait till the last possible second to tell the customer, leaving him or her stranded with no recourse.  That is at the heart of what my Facebook post was all about.

      So here, let me give you a little insight into what I have been dealing with since late Friday afternoon.  Everything in my day was going well until Mandy opened a letter that came in the mail from the insurance company basically stating that my surgery is not being covered. That's right, 6 days before surgery they decided to tell me it wasn't covered, and better yet, when I called my doctor's office about it, the scheduling nurse said she had no idea it wasn't covered. She told me that when she submitted the codes for surgery to them they pre-approved everything and we were good to go, or so she thought.  After talking with her I called the insurance company and after several minutes of looking things up and reading all the notes on my case file she told me that everything was good to go. Wait, what?   She stated that the doctor's office submitted one code and it was denied, so they resubmitted a new code which was approved, so that is what the letter was all about.  Which is weird because the nurse I spoke with had no idea that anything was denied and was under the impression that we were good to go, but ok great, so we are good to go then right? I said.  Yes sir, she says.  She reiterate that everything was covered and after my deductible was met.

     Five minutes later is when it all changed.  The lady I spoke with from the insurance company called back to says that she miss read the notes and that my surgery wasn't actually covered. Her reasoning was that my doctor had submitted two procedure codes and the actual surgical procedure code was denied because I have not spent 6 fucking months resting from all sports related activities, sought alternative treatments options and medication to treat the tear in my cartilage.  I am by no means a doctor, but within 10 minutes of research on the internet told me what I would imagine every first year med student would know that cartilage doesn't repair itself.   What it sounded like to me is the insurance doctor that reviewed my case seems to think that those other options are viable options to solve my issue and my doctor should have prescribed these first.  So some guy or girl that probably got all D's in med school, barely made it through their residency, couldn't find a real job, probably never practiced medicine and takes home a large paycheck from the insurance company because his job is to save them money not treat the patient.  Yes I am pissed if you can't tell.  Needless to say I blew a fucking gasket and almost tore my office apart at work.

     Where does it all go from here?  Tuesday the nurse is going to call the insurance company and try to get it covered, and if she can't she will request a peer to peer review with my doctor and the insurance company doctor.  Thanks to the timing of the letter arriving on the Friday of a holiday weekend, Tuesday is the earliest they can work on this and I may not know till the end of the day Wednesday whether or not I will be going in for the procedure Thursday morning. 

     I have just had enough with all the bureaucratic bullshit.  When I had my MRI done, it was pre-approved as well for a certain dollar amount, but when I got the bill the insurance decided not to cover as much as they said they would and I ended up having to pay an additional $500 fucking dollars. If you say your gonna cover something then just stick to your word, I am just tired of it already.  The only reason I didn't completely blow a gasket on that whole deal was because I knew I was having surgery at that point and I would have had to pay it to cover my deductible, whether it was now or later.

     Anyway, sorry for the long rant, but that is what has been going on the last couple of days.  I just needed to blow off some steam and writing about it here seemed to help.  Lord knows I can't run right now to burn off this negative energy so I had to do something.  Enjoy your holiday weekend!

Wednesday, September 2, 2015

A Few Days Away

     With just a little over a week and a half from my surgery, I can say I am starting to get a little nervous about it.  I keep thinking to myself that I am laying on the table waiting to be put under and telling the anesthesiologist "Don't let me end up like Joan Rivers" I would say.  Of course this kind of fear is to be expected when anyone is about to under go a procedure that puts you to sleep, but now I am starting to worry about work now as well.  I will be off work for a minimum of 10 days and I have so much to I need to make sure is taken care of before and while I am off.  

     Today I had an appointment at the medical supply company to pick up three items that I will need post surgery for recovery and to kick start my rehab.  One machine can only be described as two large lower leg sleeves that work like a blood pressure cuff the doctor uses.  The machine slowly pumps air into the sleeves squeezing my legs to help fight against blood clots from forming.  

     The second is literally a cooler with a pump and a hose that hooks to a large pad.  I am to fill the cooler with ice and water so when the pad is attached to my hip the pump in the cooler will circulate the ice cold water through the pad.  This is to help relieve the swelling and pain that will result following the surgery. 

     The last machine is what I will use to start my rehab.   I can only describe it as a device with a frame work covered with a sheepskin cover that kind of acts like a sling that I will lay my leg in while it slowly bends my leg.  I am to lie flat on my back for 6 to 8 hours each day and allow this machine increase the bend angle of my leg slowly starting with a measure of 0 to 30.  I am to increase this ten points each day till I can get to a measure of 110.