Tuesday, August 31, 2010

Insurance...

I think, overall, I've remained pretty calm and level-headed throughout this whole process, but today, I've had just about all I can take.

Yesterday afternoon we learned while trying to obtain the pre-certification for my surgery that because a lumpectomy (or should I say a triple lumpectomy) IS an option, that our insurance company now feels the need to send us through the process of having to obtain a pre-determination of benefits.  Meaning, that my oncologist now has to send all his dictations, my medical history, and my family medical history detailing why he feels like the bi-lateral mastectomy is the best option for me.  The kicker....even though the oncology department is faxing our insurance all of this today, it can take up to 10 business days for our insurance company to approve.  My surgery is scheduled a week from Thursday (or 7 business days).  If the pre-determination and certification for surgery is not processed before surgery we have 2 options.  Proceed with surgery and pay for all of the expenses out of pocket, or push the surgery date back.

AND the insurance company can come back and say they feel the lumpectomies are sufficient, and that's all they will pay for.

Our insurance company has ALWAYS paid things in the past.  I can't complain there.  We were lucky at what all they paid and authorized PPO waivers for, while Breanna was at Riley's.  And the same thing when Kinsey had her oral surgery last week.  They approved a PPO waiver for the doctor I wanted to take her to, because there wasn't another one within 30 miles of us, and will be paying for that at our 'in-network' percentage.

I'm sure once they get all the dictations, medical history, etc, that it will go through, but it's just nerve wrecking to know surgery may have to be pushed back because they have up to 10 days to process it, and that they have the final say if they think I'm 'eligible' for the bi-lateral mastectomy.

I really just want to scream, DON'T YOU KNOW WHAT YOU ARE PUTTING ME THROUGH EMOTIONALLY ON TOP OF EVERYTHING ELSE?!  JUST PROCESS THE DANG PAPERWORK SO THAT I CAN GET THROUGH ALL OF THIS!!!  


I'm so ready to be through all of this, and it's starting to weigh on me that in all actuality the process hasn't even really started.  From the first surgery until reconstruction is complete is going to be somewhere around 6 months, which in the grand scheme of life is not that long, but it sure does seem like it when it's the road in front of you.

But, I'm going to stop complaining now, because I'm sure it's not what you all want to be listening to (or reading). lol.  Time to put on my running shoes, go take some aggression out on the treadmill, and be thankful that we at least have insurance.  Some people don't even have that.

2 comments:

  1. insurance is so frustrating anyway- let alone on top of all you are dealing with already!
    praying for a smooth approval process.

    ReplyDelete
  2. ugggghhhh.
    here's hoping they approve...and early!

    ReplyDelete