1st PostOp Visit - Graphic Photos! (disability claim info, too)

3rd Day After Surgery - LEFT FOOT

Howdy! My mother had to go to work today (as she should), so I took a bath today by myself. Not too bad, just have to be patient AND CAREFUL. 

My dad took me to my first post-op visit with Dr. West. (Way to go Dad!!) 

I was charged my co-pay again (for my plan it's $25)
The pump was removed. No pain there. (it has no needles. tubes directly into skin.. weird.)

4 hours after pump was removed I got the munchies for two hours, then my appetite was gone again. 

All of the sutchers used are desolvable except for the ones used on the outside for the bunionectomy of my
5th metatarsal. (pinkie toe)

One screw for my 1st metatarsal and 6 screws
for my 4th metatarsal bone graph.

See the heel? It has a filler. My own bone is suppose to grow back within 2 years time.

 

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Submitting my short-term disability claim
First thing this morning I called in my claim. A few things...


1. The person I spoke to was only someone who collects information. They do not handle the claim. He wouldn't let me give him any other info outside of the answers to his questions. Before hanging up I insisted he let me speak. While some of the things I wanted to say may not be important to the claim itself I didn't want to make a mistake and leave out information that would make a difference. I wanted to give a true picture of my recovery challenges.

After saying my peace, he was very humbled at what I had shared and changed his tone completely. So that was that.


2. A few days later the person handling my claim called me. She asked if the bunionectomy was done with or without osteotomy. (she also asked for tons of personal data, contact info, dates, etc.) Apparently this is a big factor on how things are categorized and approved on their end.

I did not have this answer on hand, but called Dr. West on his cell phone and quickly got an answer. My Chevron bunionectomy was with osteotomy.


3. She's suppose to contact my surgeon [and my employer if necessary] in order to make a complete decision. But she shared with me that she would be approving me for 2 weeks disability. I was taken aback by the short time, but not too shocked as my experience so far has taught me that people really think Brachy correction is as simple as a bunionectomy (never mind that I had TWO bunionectomies done on the same foot WITH the Brachy at the same time!) 

I then shared with her my real situation and real challenges post-op. For the most part because I have a desk job and it's considered foot surgery, it's viewed as hardly anything major. But I pressed in to paint her the real picture. I was polite, but I worried about sounding like someone who just didn't want to go back to work. Which is not the case at all.


She then decided to approve me for 4 weeks with still needing to speak to my surgeon. So things are pending right now.

2nd Day After Surgery - LEFT FOOT

Last night was a little rough. The pain woke me up and I had to take some pain killers. When I feel the numbness wearing off, I can feel my calf and more pain in my foot. I still have not felt my first metatarsal though!  ;o) (Large bubionectomy)

I'm in good spirits. I thought being medicated would mean I'd be sleeping much more than I am. In fact, I think I have too much "awake energy". I think I'd rather be more sleepy.

I've removed the tea from my diet that I've been drinking. Getting rid of that caffeine is helping me rest more.

I just tried curling my toes and my 4th toe bent a little! YAY!

(I'm very determined to get as much flexibility in that toe as I can. In fact, I'm not accepting the report I got from both Dr. East and Dr. West who both said I would not retain the ability to bend my toe as I have before the surgery.)

FYI: I'm taking my antibiotics every 6 hours. And I'm really not very hungry.

Note: I called my doctor back home, Dr. Yes, who will be doing my post-op care (12 weeks) to schedule an appointment as soon as I return. It's important to do it now so you're attended to as soon as you get back home.


Tootles!

1st Day After Surgery - LEFT FOOT

I haven't done much as you might have guessed. My appetite is gone. My mom had to bathe me. (brought back memories ;o)

Although the bathroom was very near by, it became necessary for a bucket to be placed near my bed so I could do urinate. Doing this was a great help. I have disinfective wipes for my hands and my mom faithfully emptied it daily. (Tip: if you're going to do this, fill the bucket with some water first!)

My leg feels very heavy and every movement is cumbersome.

You may have noticed smalls tube coming out of my bandages in my last post.... well, that's the Infusion Pain Pump. I had asked my surgeon if I could control the amount myself (with a max-cap of course), I wanted this control because... what if I didn't need it as much? (Again, I hate pharmaceuticals!) He stated that this would not be possible. So be it.

(Tubes from Infusion Pain Pump)

(There are no needles under the tape. )

I have one pump, but two tubes. This was necessary I think because I had so much done on one foot, the two bunionectomies and Brachymetatarsia correction.

The pump is a round ball. (It has to be carried around by you.) I was given a small fanny-pack to carry it. I use it around my waist and/or neck when walking around on my crutches. The ball is warm.

As the days went by it administered Bupivacaine on a set auto-cycle. I had this on for 4 days. I hardly felt it when it administered. I had to be very still and it had to be completely quiet for me to feel a vibration inside my bandages for me to feel it administering. No pain with this.

 As each day passes, the ball shrinks inside.

Incidentally, inside the fanny-pack I found a brochure that shows that the infusion pump comes in 3 controller types. "Select-A-Flow®",  OnDemand™,  or  Fixed Flow Rate. So perhaps your doctor may choose a different flow than the "Fixed Flow" my doctor insisted on.

Note: I only felt nauseous once during this whole thing. Today was that day. It was just for a few minutes. I had one dry heave and it was over. I think it might have been because I took a pain killer and antibiotic at the same time.

Tootles.

 

SURGERY DAY!- LEFT FOOT

Up at 4:30am. I have to be at the hospital by 5:30am. My surgery is scheduled for 7:30am sharp. Remember to choose something comfy and easy to wear.

At the hospital I had to sit and answer questions (DOB, SS, etc.), give ID, insurance card, choose someone for Power of Attorney, pay hospital balance up-front (my insurance covers 90%. I had to write a check for approx. $370). I received my wristband and was reunited with my mom.

Later I was taken by a nurse. I was weighed. I changed. They wanted ALL my clothes off even though this was surgery for my foot. I kept my undies on. I was asked to state what day it was and what was going to be performed on me. They also took a urine sample. After giving the sample I realized it was for a pregnancy test. But I had already had this done (paid) for such a test for Dr. West some weeks earlier. I explained. They made a call to the lab to disregard my urine sample. (yay!) My IV was also done at this time.

I had to sign a form at this time for the crutches I would need later. Apparently, the crutches are billed separately by a company other than the hospital.

I sat on a gurney with the privacy of a curtain and my mom soon was let in to sit with me. I was given a marker and was told to write "yes" on the foot that was to have the procedures. I did, but I also drew a happy face on the bottom of my right foot. I put my sock back on that foot to hide it. I was hoping that in the operating room it would bring a few chuckles. (I was pretty sure that Dr. West would view my right foot while working on the left. My right foot does not have Brachymetatarsia.)

Soon an intern who works with Dr. West came over, introduced himself and asked if he could see my foot. I removed my sock. He took a look touched a few toes and was done. He asked if I had any questions. I said, "Yes. I was told I get a continental breakfast with this thing. Someone lied to me." ;oD This of course broke the ice. (I wanted everyone to experience a little humor before going into this thing.) 

Another nurse soon came who would be involved in the surgery and introduced herself. She too asked me to name what was being performed on me.

Then Dr. West came in. We were all in good spirits. He took the marker and signed his initials right next to where I wrote "yes" on my foot.

He took a digital picture of my foot, them placed his hand on my shoulder and bowed his head to prayed for me. Yup, Dr. West is a believer! ;o) He prayed aloud with me and my mom right there while the two nurses where going through paperwork. 

There are times in life where you feel you are perfectly situated at the right time and place... this was one of those moments. (I can not tell you if my surgeon does this with all his patients. But I feel pretty confident in stating that if his patients let it be known that they are followers of Jesus Christ, that he will most likely feel the liberty to express and show his own faith as well.)

He left before my mom could start blubbering. ;o) She was very touched by his gesture of prayer. Soon we were making jokes again.

For the most part my humor was accepted. The Anesthesiologist was a little taken aback however. Her point being that if I'm cracking jokes she is unable to determine if I'm really disoriented or not. "Surgeries are canceled when patients are asked questions and the wrong answer is delivered." (I understood her point and told her I understood, but her delivery on this point wasn't the best.) I felt that she is the one usually cracking the jokes... (maybe I was stealing her thunder?) a few minutes later she administered the anesthesia in a forceful manner.... it was very painful. (I had anesthesia admitted 10 years ago for a surgery and felt no pain whatsoever.)

Considering the anesthesia isn't delivered by needle directly into my arm, but an injection into the IV tube.... you'd think there would be no pain... but she managed to delivery it too quickly and the pain was practically unbearable. 

No time to complain as I would very soon be out. Approximately 4.5hrs later I awoke to Dr. West saying something to me that I couldn't make out. He left. I felt myself go under again, but not before I felt someone remove my catheter and hand me a zip-lock bag with my undies in it! LOL. Then I awoke to see a woman at the end of the gurney trying to tell me how to use crutches. It was much to early! I couldn't understand her. I was disoriented. They even got me up and placed the crutches under my arms. All I kept saying was, "I really shouldn't be on crutches right now." ;o) Drrrrr.

Moments later I was being wheeled out. I was in and out of consciousness. I then found myself at my parents, in bed, and took the strongest pain killer as directed by my doctor (Roxicet). The day before he instructed me to not wait for pain, but to take it as soon as I got back from the hospital. 

This is what I was looking like.

Gauze. An ace bandage on top of that. Cotton wrapped on top of that.Then a fiberglass splint running from my toes to my calf. Then TONS more cotton wrapping. And finally another ace bandage.

My leg was numb from the knee down. I was able to move my first 3 toes forward and backward— that very night. (one can do a lot when you're numb. ;o)

All this waiting and it's finally done, pheeew....

My Accomodations

My parents live out west, so the first 8 days I will have their help. 

After my pre-surgery doctor appointment we headed straight to the pharmacy to fill the prescriptions. I decided not to have the Zofran filled. (I hate pharmaceuticals!) I did this because I know my body pretty well. Do what is best for you.

I also stopped and got some flowers for my room. I figured I wouldn't be outside much, and I really love flowers. My mom was a gem! She had the room set up beautifully and practically. Where would the world be without Mom's!!!???

THANKS MOM!!!

Day Before Surgery - LEFT FOOT

The day before surgery I met with my surgeon.

1. I paid my co-pay for that visit (with my plan its $25.00)

2. He reviewed the negative risks

3. He reviewed pre-op things for me to do

4. New xrays were taken, even though I had xrays done & sent to him several months earlier. (I was told, legally he could not perform the surgery if he did not take xrays now.)

5. He gave me 4 prescriptions:

• Cephalexin 500mg capsules (antibiotic)
• Hydrocodone BT-IBU 7.5-200 tablets (pain reliever and anti-inflammatory)
• Roxicet 5-325 tablet (pain reliever and can reduce fever)
• Zofran 8mg tablets (prevents nausea)

6. The following paperwork was given to me to sign to verify that I accept, consent, and understand:

• Instructions of what not to do before surgery (including eating or drinking ANYTHING 8 hrs before surgery)
• Instructions on what not to do and do after surgery
• An overly simplified diagram of the 4 surgeries that would be done on my left foot
• Alternatives, Adverse Effects, and Complications (including Adverse Effects of toe amputation and/or limb amputation, nerve damage, chronic pain, repeated surgery to correct condition, and more. These papers were verbally reviewed with me by my surgeon before given to me to sign.)

After signing all the papers I asked for photocopies for my records. My request was met with a surprised look, but I was accommodated.

Later.

Last Tips Before Surgery

Howdy,

Well, it's about that time! ;0)

Before surgery you should take plenty before pictures of your foot. At least weight-bearing and non-weight bearing. Curled toes also, as you want to be able to track how much the surgery affected your flexibility/mobility.

Feet should be clean with no nail polish. On the day of surgery you should use no lotions, oils or perfumes.

Another thing I did for myself is to not completely remove the calluses beneath my feet. I could be wrong, but I feel that these are clues for my surgeon of how I walk. This should tell if I'm favoring a particular side. My surgeon seemed surprised to see the extent of them before. So while I've smoothed them out a bit, I felt that having them is a good source of communication for my surgeon to know how my Brachy and Bunions have affected how I walk, etc.

I'm on my way! Ciao! ;o)

Vitamin Suppliments and Surgery

I sprout my own wheat!

I called my surgeon to ask a few questions and discovered that he recommends that I stop taking my natural supplements. (Glad I asked.) He says there is little to no regulation on them and therefore can have some sort of blood thinner in them. I should stop taking them 1 week before surgery. "Boooooooo". I really want to keep taking my Echinacea, etc. but we don't need surgical complications do we? ;o) 

I think it's ok for me to keep taking my Aloe though. I didn't ask. I'm just assuming. (I didn't bother going into the Raw food thing with my surgeon. I work in an aspect of the pharmaceutical industry and know the mindsets of practiced medicine in this country. I think the article at the end of this post is helpful for any raw foodist when it comes to medical procedures.)

I have found the whole Raw Food thing (living foods) can be very off the radar for doctors. I do not subscribe to the fanatical delivery often used by Raw Foodists. Although I cannot point fingers because I was that way too. I don't blame myself/them for that either. I understand where it comes from. When your aches and pains go away and you are rejuvenated unlike any other time in your life... you get a little kookie. ;o) You want people to benefit too.

But I didn't like the negative stuff that was wrapped up in that kind of 'sharing'. So I decided I would do what was best for me and people do what's best for them. There is more than one way to be healthy and not everyone is the same. (Here is a video that puts it into words pretty well... be open minded and patient when viewing. ;o)

IF YOU ARE A RAW FOODIST AND ARE GOING INTO SURGERY.. READ THIS ARTICLE!

7 Days Left Till Surgery!! (The hospital called)

Howdy all!

Well my last day at work was yesterday. (vaca days before surgery ;o) I'm busy getting things done I know I won't be able to do when I get back. Yesterday the hospital called me to tell me the monies I will owe up front. (My medical insurance covers 90%, I pay 10%. More on all the cost details later on when the dust settles.) FYI: I will be billed by the surgeon, the Anesthesiologist and the hospital separately. The hospital is the only of the three that needs payment up-front, before the surgery.

As you know there is little information out there on Brachymetatarsia compared to other [bone] disorders. Even less blogs I think. I have found less then a handful that lend a real idea of what it's like and most of them are from people who have gone with the external fixator. 

So as they turn the fixator, the toe ever so slightly grows over time. This makes blog posts exciting I think, to actually see progress. So I'm not sure, as I will be undergoing the one-stage, how exiting regular status updates will be. I'll do my best. ;o)

Tootles!

Cost of Pre-Surgery Tests

One of the aspect about my Brachymetatarsia research is that I found no personal blogs stating the cost of anything. Not the cost of their prescription medications and certainly not their medical bills for the surgery. I had one post-Brachy person tell me they would and never did. *shrug*

Anyway, remember those unexpected surgery clearance tests I had to get before surgery? Well here are the costs of those.

(FYI, two doctors here at home found it odd that things like an EKG were being asked for. They felt because of my health and age it was unnecessary. Overkill. I can't speak for Dr. West, but my feeling is that he probably realizes this BUT because I am traveling for this, he may want to make sure nothing stands in the way? From my end there is a lot riding on this.  I'd like to think that's the reason why.)

Keep in mind doctors charge more in the east than in the west.

Office Visit: $365.00
Venipuncture: $30.00
Urinalysis: $30.00
Pregnancy Urine: $40.00
EKG: $100.00
Laboratory Fees: $155.75

TOTAL: $720.75
Portion paid by my insurance: $680.75
Portion I pay: $40.00 (co-pay)

Surgery is About 2 Weeks Away

Howdy! Ok so in approximately 2 weeks I'll be having surgeries on my left foot. My time is spent trying to prep everything I'll need when I return home. (and shoveling tons of SNOW!) 

I'm stocking up on things and cleaning. I'd love to get my taxes done too! ;o) Let's see how things turn out.

I'll have photos and info when I get back for sure. ;o) 

Thanks for your prayers!

Pre-Surgery Tests Are Done

© www.noao.edu

(MERRY CHRISTMAS!)

My pre-tests are done. Before doing so however, I did contact my surgeon's office and ask if getting these tests done 8 wks before was ok. (Some hospitals have stipulations about the timing of surgery-clearance results). Eddie told me there would be no problem (I have that in writing), so I went ahead and had it done at an internist's office. (I didn't know any internists, so my OBGYN recommended someone.)

It's the holidays so hopefully by Jan 3rd, the results will be faxed to my surgeon. My flight is booked and the only thing I am concentrating on now is me— my health. I'm making very specific efforts to detoxify myself in a balanced way. Physically, mentally, emotionally, etc. To prepare myself mentally and spiritually for the surgery itself and post-op.

There may be traveling stresses, physical pain, and emotional events in store. I'd like to be as prepared as I can to handle them all intelligently, patiently, and happily. I just feel I need to do this.

So that's it for now. Stay well my friends!

"Shoot for the moon and if you miss you will still be among the stars."

                 ~ Les Brown

Pre-Surgery Tests

Now that the surgery is scheduled (and my flight booked) I've received additional paperwork from Dr. West's office. It better prepares you for what needs to be done before surgery and after. I came across some unexpected things I thought you all would appreciate knowing. 

Dr. West has written out a prescription for me for the following:

    Complete History & Physical

    Surgery Clearance

    EKG

    Pre-operative Labs

    CBC with Differential

    Complete Metabolic Panel

    Urine Analysis

    Pregnancy test if female is between 14-50

I never considered so much had to be done for this surgery. I'm happy to say I have good health. I'm not familiar with medical procedures really. So I don't know if I have to go to several places/doctors to get all this done or not. I don't have a general family doctor. I do have an OBGYN though. I have a call into him.

I hope to speak with him today and tell him about my surgery, and about the list I've been given. I am hoping that my OBGYN will: 1. be familiar with these needs, and 2. be willing to sort of hold my hand a bit in getting them done. I would think some could be done out of his office.

But I think he would have to tell me where I need to go for those items that can not be done in his office. I will assume the best and wait.

That's it for now. ;o) Tootles!

UNEXPECTED Post-Op Option— Disability

I've learned some things.

I had been trying to set myself up to work remotely from home during the 12-week post op. It's how I assumed all along, for years, was the only way I could even consider this surgery. (I don't think it the best thing to work right after surgery, but if that's my only option, so be it.)

However, after speaking with my HR person I was informed of the following. I qualify to apply for short-term disability. Eight weeks of 100% salary coverage, and an additional four weeks at 60% salary coverage. THIS POSSIBILITY NEVER ENTERED MY MIND IN THE PAST 10 YEARS. What an amazing blessing!

Anyway, the main thing to consider is the 'applying'. It is not guaranteed.

This is what I've gathered so far:

• I have to apply for it, by phone, AFTER my surgery.

• The insurance carrier then calls Dr. West and then calls my employer. (The insurance claimant's job with this is to get me working as soon as possible) Based on information they gather, they decide to either accept or reject my claim— and for how long.

I emailed Dr. West letting him know that this was a blessing I never knew about and wanted to know his thoughts about the likelihood of it being approved for the 12-weeks. I let him know that I understood the discussion did not come from him but still wouldn't mind hearing his thoughts about it.

I shared with him my rigorous work commute into Manhattan. Somehow all the stairs and trains I take are not conducive to having one leg with non-bearing weight and crutches.

While Dr. West has responded to my emails in the past, he has not answered this email in particular.

So there you have it. If you're trying to figure out how you'll manage your post-op time, perhaps you may want to investigate this option for yourself.

I hope you are all well. I am great! I'm excited about my surgery and am looking forward to wearing flip flops this coming summer.

God bless!

My Surgery is Scheduled!

I have so much to tell you all, but can't right now. I've learned many new things and will share with you all soon. For now I will tell you that my surgery is scheduled for the beginning of next year— February.


Stay blessed!


Be sure to visit the "Keep Your Spirits Up..." on the right column!


Tootles!

Insurance PreAPPROVAL!!!!

This is a bitter sweet entry.

Today, 6 weeks after Eddie submitted the paperwork for Pre-approval, I decided to leave him a message to check in. Afterwards I sent one email to both Dr. West and Dr. Yes (CCing Barbara). (If you want to know who's who among these names just click on the green "Cast of Characters" link in the right column.)

I was just FYI-ing both doctors about the pre-approval so they would know why things weren't moving forward. (I expressed my disappointment.) Having never met Dr. Yes, I wanted to stay on his radar. The email of course would serve both doctors to now have each others' contact info so they can begin to communicate about the procedures and post-op care as they need.

Coincidentally, only 5 hours after sending that email, Eddie called me to tell me the insurance had just faxed over the approval. Amazing! lol.

So here's the conversation:

Eddie: "So your insurance will cover this surgery."

Me: "Well wait, there is more than one surgery? It's four surgeries right?

Eddie: "Yes, Brachy, Bunion, Heel and Bunionette. But they approved only the Brachy and Bunion. The other two don't need pre-approval. So do you want to schedule this then?"

Me: "Thank you. Eddie I think you know by now that I'm a 10 question sort of person. (giggling) So I really need to get things clear before going ahead and doing this. I have a lot of things to organize and arrange. The flight, the care for my dog, my job, etc. So my insurance will only cover 90% correct?"

Eddie: "Yes that's right. The approval isn't a guarantee of coverage either, as this isn't a claim being submitted."

Me: "So do you all bill your clients for portions not covered by insurance?

Eddie: "Yes"

Me: "So when is that arranged? I don't really want surprises later and I want to be responsible. I don't have credit cards. I want to be able to pay in installments. Can I do that?"

Eddie: "Yes"

Me: "Do you charge interest?"

Eddie: "No."

Me: "OK. Because I do not want to take out a loan for the balance. My credit score is very very good though. I like paying me bills before they are due."

Eddie: "Well I could give you a close figure, but not exact."

So we agreed he would get me a close figure by end of week.  
Here is the BAD NEWS!

He told me that we would have to schedule in FEBRUARY of 2011!!!!!! I nearly fell off my chair! That's 3 months away! (It's already been 4 months with all this xray and going back and forth stuff) I told him I was very surprised and disappointed. He explained something about the holidays being on particular days and therefore they really lose almost half of December.

When our conversation was done I realized I had just sent an email to my doctors informing them of the insurance hold-up. So now I had to send them the news of more hold-up and why. (of course you realize that I'm emailing Dr. West who will know all these happenings from Eddie and Barb. But just in case the communication gets lost in the shuffle at their office, I'm informing him as if he didn't know) Again I expressed my disappointment in the email.

More than not wanting to pay for a Holiday-priced plane ticket, I wanted to get the left foot onto the 2010 papers. This way I would have no problem with the right foot on the 2011 papers. (Both in the same year.... I'm thinking I may reach some sort of cap or something?) (this concern turned out not to be a concern. It turned out to be more profitable for me to have both done in the same year.)

Anyway, so that's that.

One last thing. Dr. Yes answered my email right away. Just a reply to me though, not a "reply all". He shared his availability schedule with me because I had asked him to. So I know what month not to book the surgery. He also shared an interesting little thing with me:

"Incidentally, 30-60 days seems awfully long to get a pre-cert. Usually here in the East it takes 7-10 days at the longest, with most insurances within 72 hours."  ...hmmmmm.

Next steps:

I will discuss the estimated balance with Eddie by end of week. Then I'll have to shuffle things on my end to align my time off, dog care, see about flights, blah blah... then call Eddie back. Hopefully by then the two dates he gave me for February aren't taken. I'll schedule the surgery, THEN book the flights. ;0)

Let's see what happens... would be nice if after receiving my email Dr. West would find a date this year. But truthfully, everything has its time so I'm ok with February. There may be unforeseen blessings in having it then. ;o)


Tootles... 


pst...CHRISTMAS IS COMING!  ;o)

===============================================

WAIT! WAIT! WAIT!

I thought I was done— sorry! I logged off and sat to read my snail-mail. I just received a letter from my insurance carrier. The postmark on the envelope is Nov 3rd. The letter inside says, Oct 29th. (So does this mean that Eddie would have contacted me today regardless of my call into him and my email to Dr. West? I think this shows that it is a possibility.)

The envelope has my address on it, but the letter is written to Dr. West. My insurer sent me a copy. It says (verbatim):

Dear [Dr. West]:

We received a request for a voluntary predetermination of coverage for [patient's name] for the following service/procedure(s):

• Surgical Procedure Foot-Toe Brachymetatarsia Correction 28899-LT

After reviewing the information submitted we have determined the service/procedure(s) to be medically necessary and a covered benefit under the member's plan.

This voluntary predetermination of coverage decision is not a treatment decision, a medical consultation, or claim approval. In providing this predetermination information [X-Y-Z insurance] does not guarantee the service/procedure(s) will be covered. Claims submitted will be paid in accordance with the member's eligibility status and all benefit plan provisions in effect at the time the service/procedure(s) is actually rendered. All rights and obligations under the benefit plan are reserved.

If you have any questions.. blah blah.

I just wanted to share that with you. There are those of you who have always wondered about these dealings with insurance companies. Well this is one example of how it's being handled by one of the top insurers in the US. Bottom line? It's a risk no matter how much you try to plan, or figure you deserve the coverage for paying your insurance for years without a claim. Even after surgery you can be denied. That makes my heart sink.  ;o( Gulp.

But at this point, I'm willing to take the risk. VIVA LA VIDA! ;o)

(wooooo whoooo.. did you catch that by the way? "Medically Necessary"! I have to cry at this. It's like someone saying, 'Yes I understand your pain'.  ;o)

OK. I'm really going this time.

Insurance Update

I called Eddie to ask how it was going with the pre-authorization he submitted 2 weeks ago. He returned my call the following day. He said he touched base with them last week to make sure they had everything and it seems now we just wait for however long it will take.

I will be praying most of this will be covered by my insurance carrier.

Tootles! ;-)

Who Starts the Insurance Claim?

© buildinginsurancebusiness.com

I had a call into Dr. West's schedule/cost guy (Eddie). A day later he phoned back. I wanted to touch base with him about Do's and Dont's when calling my insurance carrier before-hand about the surgeries. I don't do this everyday, he does. I didn't even know if it was necessary to account with the insurance carrier.

I know that verbiage and codes are everything with insurance claims and didn't want to hinder my objective of having this all covered as much as possible.

I found out that Eddie would contact my carrier himself. 

1. He would first go into the "prior-authorization" stage. He made it sound that this has to be done with everyone and every carrier. 

2.This may or may not lead him to the "pre-determination" stage. Sometimes carriers require it, sometimes not. (I do not know how a carrier determines if it's something they will ask for.)

This pre-determination state is sort of a submission of paperwork on behalf of the doctor's office. Remember those questions Dr. West first asked me in his office? Well guess what? His notes on that get submitted in this paperwork. You do the math on how important my answers were.

Eddie said it takes 30-60 days to hear back from the insurance carrier on this pre-determination submission. Of course I am praying that through some heavenly provision it will be much less than that. I told Eddie that, the more time that passes, the more expensive my plane ticket will be because of the holidays. (Eddie also has to put in a request to Dr. West for all his notes to put into the submission, which would take a day or so.)

On the phone Eddie was reading my records to himself. He jotted off 4 long medical terms for what would be done on my left foot. So I asked, "So that's the Brachy, the heel (bone extraction), the Bunion, and the Bunnionette, right?"

So you guessed it, the insurance company will see this as 4 surgeries. 4 claims. And the bills I will get will most likely be segmented between all sorts of things. You are treated specifically by an anesthesiologist for your 4 hour snooze, he/she is paid separately I hear.... things like that.

Here is a BIG question I did NOT ask, but will next time I speak with Eddie. Dr. West gives an approximate cost in his preliminary paper-packet introduction to all this. About $8000-$9000. It includes Hospital/Surgery Center, Anesthesia, Surgeon's fees, AND FOLLOW UP OUT WEST FOR 6 MONTHS. — My question is: "For the patients that stay the 10 mandatory days there, but then do all the post-op with another doctor back home, is the price less?"

To me and many of us, we would expect that is should be. I'll get back to you all on this.

I have to also pay all the fees for all the post-op at home through Dr. Yes. I wonder how many claims that will be into my insurance carrier... to see him every 3 weeks, have the cast removed, xrays taken, and a new cast put on... for 12 weeks. And he is listed as OUT-OF NETWORK for me. On average, doctor's in the East charge more too. Just a lot to chew on is all I'm saying... and pay. ;-)

NOTE: I have also thought that having one foot addressed at the end of the year is a benefit! Because then the second will be in a whole new year. I'm hoping that when it comes to insurance red-tape, that it will work in my favor with any annual limitation caps. 

It will however, not help me in the $250 annual deductible cap I have. Any deductibles I pay this year will not go towards that starting the new year. Oh well, can't have everything. ;-) (Now 10mo after the surgeries, I can tell you that it worked in my favor financially to have both feet address in the same year, because I then met my maximum out-of-pocket amount by the time I had the second foot done. This was not planned, but it happened that way due to scheduling issues at my surgeon's office.)

I hope all this information will help you in your surgery plans!

Tootles! ;-)

Insurance Coverage— Preliminary Steps

Hi all!

Although not planned, a moment presented itself for me to mention my potential surgery to my boss. I thought it would be unprofitable for me later if I didn't take it.

So now my boss knows surgery is probable before the end of the year and I will be needing to work at home post-op. Preliminarily, it seems fine so far.

So this leads to Insurance prep and scheduling.

First,

I went online to check my insurance coverage:

      1. I went to my job's "Benefits" online, and

      2. My insurance carrier's website

On my jobs benefit site:

-I verified my annual deductible-cap for the year (The maximum you will pay in deductibles annually.)

-What percentage of "out-patient" procedures my plan covers

-and other things like cost of generic prescriptions, etc.

In my Insurance carrier's site:

-I re-verified that Dr. West is indeed considered In-Network (YAY!)

-I discovered that Dr. Yes is considered Out-of-Network (not sure if this is really bad yet…)

I want to avoid big surprises later so I also went online to see if I could find articles about how to verify coverage (the smart way) with my insurance carrier. This was not easy to find.

So I decided I would call the person at Dr. West's office who handles cost and scheduling (we'll call him Eddie) to see if he could lend some Do's and Dont's before I call my insurance company to verify the coverage of these procedures. (Remember, if Dr. West is able to work on all three of the issues on my left foot that means it will be submitted as 4 different surgeries.)

So now I sit and wait for him to call me back. ;-)

Hasta luego!