APPROVED!!!!!!!!!!!

  

     My surgery has been approved!!  Finally after all the doctors visits, phone calls back and forth and six weeks of physical therapy the idiots at the insurance company finally saw what everyone else already knew.  

   

     At first I wasn't sure if it was even going to happen after my follow up visit with the surgeon.  They submitted for the surgery and a week later I got a letter in the mail from the ins company that my request was under review and required more information.  Of course I received this letter when I got home from work on a Friday which meant I had to worry and stew about it all weekend.  Monday morning I called the surgeon's office and spoke with his nurse and she stated that she had already preemptively called the ins company, gave them the info they required and that were satisfied and that we had the green light.  She told me to disregard the letter, but could you blame me if I didn't 100% believe her.   I hung up with her and called the ins company, and of course they would tell me that in fact, no the surgery was not approved and was still in review status.  She did say, however that if the nurse just talked to the review board that the board my not have updated their records yet.  This being on a Monday, I decided I would give them a call on Thursday and if the status had not changed then I would call the surgeon's office again.  The same day I was going to call the ins company I received a letter from them stating that my requested procedure was "medically necessary" and that I was approved to have the surgery.  Of course I called to verify all this, and was so relieved that all this was finally over.  I have had my pre op screening at the hospital and in a little more than a week my journey back to running will begin.  

     I want to wish everyone a Happy Thanksgiving for tomorrow!  

     Those of you heading out and braving the black Friday weekend of shopping be safe and remember no amount of discount or deal is worth treating another human being with disrespect.  And that goes double when you are dealing with all the retail employees that are out there just doing their jobs and trying to support their families as well.

 

Physical Therapy is Complete

     It seems like a lifetime ago that I was running consistently and having something to say about it.  I do apologize for my posts being few and far between lately, but there just hasn't been much to say that hasn't already been said on my current situation.  However, I did want to give a quick update since I finished my 6 weeks of physical therapy and I thought this would be a good time to catch you all up to date.  

     As far as therapy goes, it was successful in the job of increasing my flexibility and strengthening my legs, hips and core, but to answer the sixty four million dollar question, I still have pain.  To be completely honest I am having pain right now as I type this.  The intensity of the pain and aching varies depending on my day, but what I have noticed is no one thing is the trigger.  If I stand or sit for most of the day is flares up or it can flare up no matter what the combination is for the day.

     If I remember correctly the last time I was running regularly was early July, and the pain has continued during this rest period. Needless to say that if I was never to run a step or do any other "sports" related type of exercise, as the insurance company calls it,  this is affecting the quality of my everyday life.  My therapist says that there is a chance that I could continue to have pain even after I have the surgery done, but to be honest I would rather get the surgery and still have pain than never get the surgery and always wonder if it would have fixed it.  Plus, don't forget the extra bone protrusion that was rubbing on the cartilage and caused the tear to begin with.  If I don't get that taken care of I am sure to have more problems in the future.

     Anyway, I have a followup appointment with my surgeon on Friday to discuss where things go from here.  I hope to have some news to share from that visit, but I am thinking it will go like this, Lets set up a new surgery time and submit it to the insurance company and see if they will now approve it.  Well, all I can do is cross my finger and hope at this point! ;)

Stick To Your Word, That's All I Ask

      WARNING ANGRY RANT ABOUT INSURANCE COMPANIES AHEAD.  PROCEED WITH CAUTION IF YOU ARE EASILY OFFENDED OR THINK MEDICAL INSURANCE COMPANIES ARE THE BEST THING THAT EVER HAPPENED TO US...

     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!