July 19, 2010
Out of My Hands
I am walking this very fine line today and feel like an absolute crazy person. I can be reduced to tears and a temper tantrum in mere seconds. I'm supposed to have surgery tomorrow. However, my surgeon's office is recommending I cancel the surgery. My options are to either cancel or pay $3,475.00 up front tomorrow. I don't know how many of you have $3,475.00 stuffed in your mattresses, but I don't. I'm lucky if I have $3.00 in my wallet at any given time.
My surgery has been scheduled for weeks. My insurance decided they wouldn't pay for the one part I desperately need, the alloderm to give me back tissue that is long gone, because they deem it "experimental" and "not medically necessary." They decided this last week, which gives me little time to get anything changed, especially since my surgeon was on vacation last week and will only arrive in the office within the next hour or so.
Today, my insurance company told my husband that my surgeon can request a peer to peer review and appeal the decision directly to the medical director. Today, they tell me this. Today. According to them, this wasn't even an option last week.
If they wouldn't have had their non-caring heads stuck up their lazy butts for the past several weeks, then perhaps I would be mentally getting into the surgery zone instead of figuring out how I can refrain from killing someone today.
To me, it's simple. Almost three years of problems need to be fixed now. I waited weeks to get in with this surgeon and weeks to get on his surgery schedule. It's been months since I begrudgingly went back to a surgeon for help. Months. If I cancel now, I won't be able to get back on the schedule for many more weeks. Then I'm back teaching. You can't take time off for surgery when you're an adjunct and teach two days a week. Which means, I have to wait. . . again. . .
I have to wait until I inevitably bump my leg again and the screw cuts me from the inside out, again. I have to wait and walk around with a painful knee for who knows how many more months. I have to wait again.
I could seriously throw my lap top across the room. I am more angry than I have ever been. I am an emotional wreck. Why can't anyone else understand how tired I am of dealing with this? Why can't anyone else understand that waiting is not an option. I am beyond frustrated. I am beyond tired. And I can't help but feeling like there isn't a soul in this world that gives a crap or can help me right now. It is out of my hands, and that is perhaps the worst possible feeling of all.
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Things You Could Care Less About
I am so sorry that this is being such an ordeal for you. It’s unfortunate that a lot of our health issues have to go through a lot of bureaucratic B.S. before anything can actually be done to HELP us. I’m really, very sorry for the level of suck that this whole mess has become and I hope someone brings you a cookie or something so at least you can smile for a second or two today 🙂
Sending you positive thoughts, and hoping for a fast resolution to your challenge.
I’m so sorry to hear about this. I understand the frustration, anger and tears. The only thing worse than it being something that plagues you every day is when it’s something your child needs. I fought the insurance companies for many years for my child without any success. We (both my husband and myself) had to get second jobs to pay for private theraphies and to pay for the specialists. And that was with ‘good’ insurance.
The industry is rife with problems because it is based on a company trying to make a profit on people who need medical care. The only way to do that is to deny as much as possible and standardize as much as possible. People, however, are not standardized models and need maintenance.
Bottom line, this sucks. The right thing to do is to get you the surgery you need to function. It’s frustrating beyond belief that others can see that they need to do the right thing. ((hugs))
This is exactly what our insurance company does to us EVERY TIME WE NEED SOMETHING. It may be a small charge or a big unwarranted denial. There is something seriously wrong with for profit medicine and the insurance companies in this country. I pay my premiums, deductibles, co-pays on time…why can’t insurance companies at least pretend not to be the weaseling liars they are. If I were you I would do the peer to peer review, get the surgery then threaten to sue. Consult a lawyer. We’ve found that once the company realizes you are serious and have the “balls” to take them on they only act like asses 50% of the time. I am so mad on your behalf…having been there I know what it feel like.
I sent a recommended lawyer an email today. He is calling me this afternoon. I am done.
You can get the PA Insurance Dept involved as well: http://www.portal.state.pa.us/portal/server.pt/community/file_a_complaint/9258
Oh my…well, what I WANT to say is censored, BBM, but I think it’s pretty much a fact that all of us are with you in the “pissed off boat”! I can’t believe that stupid insurance company says it’s “Not necessary”! That’s nuts. I think I’d agree with Eric M and file a complaint with your state’s insurance board, with anyone that will listen. It really sucks that a bunch of chair jockeys can dictate how/what kind of medical care you get from your doctors. I disagree with “managed health care” because it DOES cause problems for people.
Here’s hoping that the lawyer you contacted can help you.
((((HUGS))))
I know how this feels, sort of…not exactly. In my case it wasn’t the insurance companies being asshats, but just that feeling of being out of control and knowing that things were not going well. Ugh. When my mom was sick, they put her on anti-depressants that changed her personality. She was a couple of hours away from me, so I couldn’t go help every day like she needed. Did she get a therapist to talk to about her depression? No. Just pills. And she was getting worse and worse and was in a lot of pain, and so refused to do the physical therapy she needed to do to recover from bypass surgery. And all the doctors kept telling me was that the anti-depreessants take time, that it takes 6 weeks sometimes before people start to feel like themselves again. And she didn’t have 6 weeks. I sent letters and made phone calls and did everything I could think of to get her more attention, more help. And it didn’t work. I don’t know if there was anything that anyone COULD do, to be honest, but that feeling of bashing my head up against the wall…I know that, and it’s the worst feeling ever. Except maybe when she died. That felt worse. Sigh.
The squeaky wheel gets the oil, BBM! I’ve had to battle my insurance company as well. Go for the peer to peer review, because I’m betting they’re hoping you just give up and stop or pay so they won’t hafta. Sucks, but I know what you’re going through.
Hang in there!