Not Medically Necessary and Other Nonsense
On Thursday, I got a call from the surgery center where I'll be having surgery next week. They told me what my co-pay would be and everything seemed to be good to go.
On Friday, things changed.
It took one call from my doctor to reduce to me to a crazy lady who didn't know if she wanted to scream, cry, hit someone, crawl into a dark hole, or all of the above.
My insurance denied the surgery claim.
The plan for next week is that the plastic surgeon is going to open me up, remove the screw in my tibia, clean up the mess that is inside my leg, attach a piece of alloderm (commonly used for breast reconstruction surgery to attach implants to actual human tissue), cut out the nasty scar I have now, and close me up from the inside out.
The insurance has said this is "not medically necessary" and that alloderm is only approved for use in the "breast." They're also saying this surgery is "experimental," to which I'd like to say "Of course it is, you morons, because how many people have the 'common' problem of having a screw back out of their bone, complicated by the fact that they have no tissue in that area which means that the skin is basically indented and transparent. Oh, and it bruises and bleeds a lot. The screw also cuts me from the inside out if I happen to graze it on anything, even lightly."
So, in the world of medicine, where it takes almost two months to get a surgery scheduled and even longer to get an actual physician to call you back, I need two letters of medical necessity from a plastic surgeon and my orthopedic surgeon, by like Tuesday (as in tomorrow). As if that's going to happen.
To say that I am frustrated would be an understatement of universal proportions.
Because I knew I wasn't going to be able to handle speaking to anyone about anything regarding this, Mr. BBM took over and called the insurance company and my plastic surgeon's office.I tackled the office of my ortho guy and the lady on the other end of the phone from me made the mistake of saying "Humph, well I can't guarantee that he can have a letter for you." Yeah, because it's SO hard for a physician to dictate a letter and have someone type and fax it.
She was about ready to hang up the phone, when I reiterated that my ortho guy said he would do whatever I needed him to do so I can get this taken care of and that he, himself, had offered to write a letter for me. I told her that I didn't wait until the last minute to ask him. The insurance waited until the last minute to deny the claim, not even two weeks before surgery. This isn't my fault and I clearly need some help. She repeated her line and I had an internal debate about whether or not me telling her off would expedite the process or not. Instead, I opted to tell her that the screw is soon going to come out of my leg on its own if it's not fixed. I also gave her the visual of it cutting me from the inside out. I'm hoping that will motivate her to be a bit more helpful. My gut tells me it won't.
In the medical profession, people are just so used to saying the word "no" that it seems they say it without even considering the desperate person on the other end of the phone. Mr. BBM tells me I am having this surgery whether it's approved or not, and that we'll spend our lifetimes fighting the charges if necessary. I just wish something about this whole knee business would be easy, just once.
Saying Goodbye to a Long Lost Friend
When I went to Pitt, I volunteered and worked for Sexual Assault Services. I started out presenting programs to freshman, fraternities, sororities, and athletic teams on campus. Whenever we did these presentations, we did them with a partner. Although the coordinator really liked having male peer educators, it was tough to find good ones. One day, I was paired up with a guy named Jay. I was nervous. I had never met him before and I wasn't sure what to expect.
I never should have given it a second thought.
Jay was an amazingly warm and friendly guy. And he could turn it on in front of a group of people like no one else I knew. We instantly clicked. We stayed paired with each other for almost all the programs we were asked to do; and each time we did a program together, we nailed it. It wasn't long at all before we were hanging out after presentations and becoming really good friends.
Jay was not your typical guy. We would spend hours talking on the phone about all kinds of things. If I close my eyes and think about him, I can hear his laugh. He had the BEST laugh and the biggest smile you've ever seen. Almost as soon as I met him, I began thinking "Who can I fix him up with???" He was one of those guys.
After a couple weeks of getting to know each other, we were having a great conversation on the phone the one night. We would always fall into this funny conversation pattern of talking about the relationships that didn't work out. As I was telling him about a classic jerk in my past life, he responded, "Oh my GOSH! Did we date the same guy? I swear we must have!"
After spending weeks trying to figure out which one of my girl friends I could fix him up with, the truth was out. That wasn't going to be happening.
"Honey, in case you haven't figured it out yet, I'm gay. Jay is gay," he said as he erupted in laughter. It was one of the funniest moments of my life. I'll never forget that phone call.
We did a lot of hanging out in the months and years to come. He and his friends were the subject of one of my projects for a communications class about "coming out" to the world and what that means interpersonally in relationships. Jay was always so completely open with me about everything. He soon became good friends with Mr. BBM as well. I actually spent my 21st birthday with Mr. BBM, Jay and some of his friends. I had an absolute blast.
Jay lived in Brooklyn and over the years we kept in touch via email and sometimes through a phone call. He used to call me "Oshkosh" because he said he just knew I was going to marry Mr. BBM and have a bunch of babies. I called him after I had Big I and he laughed and told me he was going to buy the kid some overalls. We talked about getting together, but then life got in the way and we lost touch again for a while. It seemed that every time we would email back and forth or talk though, our friendship was always right back on track from where we left off in college.
Because I'm going to BlogHer in NYC this summer, Mr. BBM suggested I get in touch with Jay again. The mere thought of this had me so psyched. On the way home from the beach, I tried to look him up on Facebook but I couldn't find him there. I did a general google search and my stomach dropped. There was a blog name that included his name and "in memoriam."
I literally shook my head, trying to shake the existance of this site and what it meant away, and thought that there are lots of people with the same names in this world. This can't possibly be my Jay. And then the pictures loaded. . . and the tears came pouring down. I felt like I couldn't breathe at first. I had to catch my breath and then I said to Mr. BBM, "Oh my God, oh my God, oh my God. He's gone."
I did some more research and found out on one of his friend's blogs that he had committed suicide in November of 2007. It happened so long ago, but for me, it's like it just happened yesterday. I left a comment on the blog and his sister emailed me this morning. She'd like to talk and hear some stories about Jay from college. I gave her my phone number and I hope she calls.
I also hope that somewhere out there, Jay knows what a wonderful person I thought he was and how horrible it is to know he's no longer just an email or phone call away.
Rest in peace, Jay. I'll never forget you.
Today, the last of the Crystal Light reviews went live. Please head over to The BBM Review and leave a comment for your chance to win!
Random Ramblings Including Having Babies with 50 Cent
Filed under: Board of Directors, Mental Strain for Mama
My life was sort of threatened today by a friend who said I better not ever go on a long non-writing stretch again because she is "addicted" to my writing.
I so love her. She should definitely visit my archives. . .often, as should the rest of you. Back then I was funny, witty and I actually wrote about karate every once in a while. Ah, the good old days.
I wish I was addicted to my own writing these days, but I think I've been sapped by lack of creativity due to a thankless data entry volunteer job and sheer exhaustion resulting from that. Being on the board of directors is highly overrated and extremely thankless. A neighbor and friend once told me that being on a board of any kind can open up avenues to paying board jobs. I would like to know where those are and would also like to say, "Hey, I'm your gal. Look no further."
Since I don't have any one thing in particular to say today, but because I'm feeling my life might be threatened if I don't put fingers to keyboard and write something, anything. . . I thought I would provide a rambling account of various things that you can do with them what you will:
First: do not ever opt to go for the heavier weights when doing that inner-thigh squeezer machine thing after not doing that machine for like eight months. Just don't do it. I went from walking like a primate from sore abs to walking like someone trying to keep a nickle between her thighs. In case you're wondering, neither are attractive ways for a young (or even an old) lady to walk. Just don't do it. Always opt for the easier weight. Always. Use this bit of advice as your work-out bible. It is practically the word of God, or at least BBM, which is practically the same thing (or not at all).
Second: I'd like to just put it out there that if I get to be the ripe old age of 75 plus and I start doing my hair like George Washington used to, and/or complaining about random things that no one in particular has any control over, and/or begin demanding liver and onions at restaurants, I'd like to put it out there that I would enjoy being put out of my misery at this point. I've given my husband carte blanche to put me out of my misery if I start acting all old and crazy and I'm now giving my blog readers the opportunity as well. Of course, you should probably discuss this with my husband first, in case he'd like first dibs. But seriously, if I'm a grumpy old gal, do me a favor. (I guess I should start working on my attitude because I'm kind of a grumpy younger-ish girl right now.)
Third: I am going to BlogHer in August and I know not a soul who is going. While many of you might think that I am a social butterfly, I might end up going all the way to New York in order to sit in my hotel room and order room service out of sheer anxiety and discomfort at not knowing a soul. It's my first time; be gentle with me, and please let's be friends beforehand, k? Email me! No seriously, email me! I am a good friend and known for buying drinks for new friends. I'm a good girl to know.
Finally: a confession. I am addicted to Jack Johnson and 50 Cent. I realize how odd and weird a juxtaposition this is, and I'm not sure what to make of it. All I know is that one minute, I am craving hearing about bubbly toes and the next minute, I am bopping around to the tune of "Have a baby by me, baby, be a millionaire." I'm thinking it's the millionaire part is what I'm liking so much, but the catchy beat can not be denied. Is there anyone who can help me out with the whole 50 Cent "be a millionaire" thing, or do I seriously need to go have a baby with 50 Cent?
Yep, I think I'll leave you on that note.
Fending Off The Know-It-All
Filed under: Mental Strain for Mama, Things that get my gi all in a bunch, Work it out
I considered live blogging the Flyers game tonight. But then I realized that I would probably be writing a string of obscenities, followed by an occasional "YES!" and then a bunch of hair-raising, "No! NOO! NOOO!" chants and I figured that wouldn't be very entertaining. Also not entertaining? That stupid doodle-doodle song that Chicago sings every time they score. Mute button on the remote? Check.
Instead of telling you about how wonderful it's going to be for Philly to take the Cup in Game 7 in Chicago (because you already know how awesome that will be), I'll tell you about how I went to the gym twice this weekend and how I can barely move, laugh, breathe, walk or blink without being in pain because of it. I seriously hate that I had to stop working out because getting back into the shape I was in before is going to be no small feat. I will also tell you that I am currently trying out a different gym for a three week time period to see if I like it. Mr. BBM has joined with me as well.
On Saturday, we walked into the gym and there were only about five other people there. Sweet! No one was going to bother me. I put on my mean face, stuck my headphones in my ears, turned up the volume and got to work. I decided I would try out my new prescribed knee sleeve to see how I liked it.
About half way through my work-out, a rather overweight and out-of-shape looking older dude started talking at me. I tried to look away but he kept at it and stood right in front of me. I pulled out my headphones, obviously irritated, and he started on this whole tirade of, "I saw you over on those two machines a while ago and I see you have knee issues. What did you do? The reason I ask is because I have knee issues too and my ortho told me those machines are bad for you. You're not supposed to use them. You're supposed to do natural movements like deep squats and lunges, not extensions." He continued on for a while and I glared at him with my most irritated look I could muster.
I then told him that I'm not allowed to do deep squats (not to mention deep squats and lunges are the most natural movement I can think of-I mean, I practically walk through the grocery store doing lunge, deep squat, lunge, deep squat, because that is oh-so-natural, GRR), that I spent 8.5 months of my life working with a physical therapist under the direction of an ortho surgeon and that I also worked out with a personal trainer for about a year who was also trained and personally experienced with ACL issues. I told him he should continue to do whatever his surgeon told him, and "I'll continue to do what mine told me." I stuck my headphones back in my ears and turned away, 180 degrees so there was no question our conversation was now over.
As we were leaving, I told Mr. BBM that my workout had been great, minus my little know-it-all knee man encounter. Mr. BBM told me the dude could have cared less about my knee. He was trying to open up a line of communication with me. I would say he failed pretty miserably. Opened and closed in a matter of about 30 seconds. Score 1 for me and my headphones.
I can not stand guys who go to the gym and interfere in my workouts. I truly wish they would mind their own business. I give off the "leave me the hell alone vibe" plenty, avoid any and all eye contact, and still, it happens whenever I go. Maybe I need to check out the gym during the "soccer Mom" times, or maybe I should just pretend I don't speak English next time.
Or perhaps to let him know I'm really not conversation worthy, I should start singing that Chicago doodle-doodle song thing. I guess it might be good for something after all.
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Restoration
I don't think I've ever gone this long without writing. It's not like me. I always have a lot to say. Lately though, I don't. I'm in a holding pattern in several ways and it's been frustrating to say the least.
When I went to see my new orthopaedic surgeon back in April, he sent me for a series of tests including an MRI and a nuclear bone scan. The MRI scan revealed a partial PCL sprain and the bone scan revealed that when I slammed my little toe on a barstool in my kitchen a couple months ago, I broke it.
He also sent me to a plastic surgeon. I wanted the surgery done in May so I could get on with my life, but that hasn't happened. Yesterday I found out why. Apparently, my file has been sitting on the plastic surgeon's desk for weeks, untouched. The woman at his office who finally figured out where my file was apologized profusely and now the process begins again.
Apparently, the surgeon thinks that the insurance company will deem my surgery "cosmetic," not "reconstructive." The fact that these words even crossed his lips is ludicrous. Anyone who knows me knows that I am much less concerned about having a pretty knee and much more concerned with having a functional knee that doesn't cause me pain. So now the phone calls to the insurance company begin and I wait. . . again.
Something tells me that I'm not at the top of his priority list. Women wanting injections of botox and boob jobs pay cash or with a credit card. Mine won't exactly be like that. I think it puts me at the bottom of the priority pile and that is annoying and maddening.
In the meantime, while unable to do karate or any impact exercises (including walking on a treadmill), I've been keeping myself busy and occupied to try to lift my mood.
I've realized that moving the two tons of delivered river rocks isn't exactly restoring my soul. The spa day that my Mom purchased for me for Christmas, that I finally used last Friday definitely helped. I've also been keeping myself busy with good friends. Although I've been in a total cooking rut, I'm trying to force myself to do things I used to like doing before all this knee business and before my Grammom passed away.
I've had good days and bad days in the month since she's died. Some days, I don't even feel like getting out of bed. It's especially hard after spending a couple hours going through her things. I haven't been visiting my Pop-Pop nearly as much as I should be, because it is so damn hard to be there, without her there.
I have friends who are worried about me. I'm definitely not myself lately, but I am working at dragging myself back. It's just a very gradual process. Packing up all my sympathy cards and my Grammom's obituary was something I got around to doing last week and it was helpful. But it's weird how certain things can set you off, when you least expect them. . . the song that was on when I was racing to the hospital on the morning she died can make me cry instantly. . . seeing a piece of her jewelry or catching the scent of her body lotion. These are things that send me reeling still. I know it's just going to take more time; and in the meantime, I'm so grateful for my very supportive and extremely patient friends.
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