Well, the rest of this winter is going to be interesting… Anytime there’s more than a dusting of snow, I’m pretty much trapped inside the apartment. Until I’m confidently on my feet and have my bearings (and probably even after I have my bearings), it’s very difficult to walk in the snow, especially when it’s a mixture of snow and ice. I know, even when I had my legs, that I was SUPER careful when walking when the streets were as icy as they were last week. So, if able people are slipping and sliding as they walk…
I FINALLY have a date for this surgery. Hallelujah! This was the most inefficient process ever. Let me recap (Sorry for the repeat..just venting here)…
I contacted the surgical coordinator for the first time, emailing her my phone # and asking her to call me, over 2 weeks ago. Three days later she calls me, telling me that she’s calling because I asked her to. Well, obviously. I told her that I wasn’t familiar with this process so she explained to me that she was waiting for the doctor to give her the coding for the procedures, then she would call insurance, then check the schedules of the doctors, and then call me back to discuss dates. Ok. And as we all know, as per my last post, that I called all week but wasn’t able to get in touch with her. Then this past Monday, she called me and apologized for not getting back to me…the office had been closed b/c of the snow….EVERY day? Fine, whatever. She told me that the doctor had given her the codes and that she would reach out to the other doctor’s office to check his schedule and would get back to me later in the week. When Thursday came and she hadn’t reached out to me, I called, naturally. And what do you know?!?!? She had an out of office message on her machine. But, wait…it didn’t snow on Thursday…so I’m confused. She must have so many vacation days!…what a nice work schedule she has.
Ok, now it’s Friday. Time to start the calling… First call was at 11:30ish in the morning. I get the out of office message, the same one from the day before. Is she still out or has she not removed the message yet? 12:30ish I call again. No more message this time, but no answer either. Hang up. Did I call every hour? Nope. Every half hour. It’s Friday and I thought there might be a change they leave early…maybe 3P, maybe 4P. So, I proceeded to call every half hour. Finally, on the 3P call, I actually have her on the phone. She says…let me call the other doctor’s office now and I’ll call you back in a few minutes. I say ok and then hang up. I regretted it the second I hung up. Crap..I should have told her that I’d hold and stay on the line while she made that call. Luckily, at about 3:30, she called me back. She tells me that it was difficult to find a date b/c, we’ll call him Dr. A, is going to be out 1 week in February and then another in March and that, we’ll call him Dr. B, is also out one week, so the earliest we can do is March 20th. Fine, let’s put that in the books. But, if something earlier opens up I’d like to move the up the date. She makes a note of it. Then I ask her what the next steps are. She tells me…I’ll email you next week with the codes and payment information and then you’ll have to call up your insurance company and ask them what they’ll cover for the procedures (using the codes to reference the procedures) since Dr. A is out of network. Oh…I thought you did that. No, I’m going to call them up to get authorization for the surgery but you’ll have to call to get the coverage information. Ok…so based on what I can gather from the limited communication that I’ve had with this woman, it’s taken her over 2 weeks to get codes from Dr. A, review Dr. A’s calendar, and reach out to Dr. B’s office to coordinate a date of March 20th. Does that sound about right? Are you F***ing kidding me?!?! Oh, and it seems like she only just called up Dr. B’s office today to coordinate a date…when I finally got in touch with her and she said she’d call me back in a few minutes after calling Dr. B’s office. Had I know she was this inefficient (I need a stronger word…inefficient doesn’t even cut it for me), I would’ve emailed Dr. A myself, asked him for the codes, then called up his secretary and asked her what dates he’s available to operate, then called up Dr. B’s secretary to get his availability, and then emailed the surgical coordinator with my options. Oh, and then call up my insurance company to find out about my coverage for this operation. And it wouldn’t have taken me over 2 weeks!!! Holy crap…
Now that I’m done venting, here’s the deal about the surgery. Friday, March 20th…happens to be the first day of Spring. I’ll have to stay in the hospital for 3 nights, with a discharge date of Monday, March 23rd. Sucks. I thought I’d only have to stay over 1 night, if at all. This is going to lead to so many more questions…Oy. I’ll have to go to the hospital 1-2 weeks prior to the day of surgery to get all the necessary pre-op tests run to make sure I’m cleared for surgery. And a few days prior to the surgery, I’ll have to go to the doctor’s office. I’ll speak to the doc on the specifics of the surgery when I see him then. Of course, I’ll also have to call him the insurance company and figure out the costs of everything and what I’m going to be responsible for…2 out of network doctors and 3 nights in the hospital…this could be VERY costly. Is there a possibility that I’ll have to find an in network doctor if it’s too much? Potentially. But, I figured I’d at least have something scheduled with this doc. If it turns out to be too costly, that’s really going to put a delay on things. As it is, I’m at somewhat of a standstill in my progress until I have this operation. So, searching for a new doc means getting referrals for an in-network doc, or potentially several, until I find one I like and am comfortable with and has experience working with amputees, visiting these doc(s), possibly getting more X-rays/tests, and then taking however long it will take to schedule surgery. I’ve been trying to schedule this March 20th date since January, so by the time all is said and done, I may not have this surgery until the end of the year if I have to look for a new doctor. And lets not forget, the 4-6 weeks of recovery time after the surgery of which I won’t be able to put on my prosthesis and be tied to my wheelchair.
I started this post last Friday. I spoke to my insurance company today (Monday). I still need the surgical codes so that I can speak to the billing departing of the doctor’s office and hospital but I called up my insurance company so I could get the breakdown of my out-of-network benefits. And I don’t know how much everything will cost (surgery, consultations after surgery, hospital stay, etc.), but it sounds like if I stick with these out-of-networks docs…a lot of finagling or creativity is going to be necessary. My insurance contact is going to work with me and try and do everything she can to help me, since this is a “unique” situation. But let me tell you about the example she gave me about someone who got back surgery with an out-of-network doctor (Mind you, I didn’t have specifics about the surgery or his condition, obviously)…Surgeon’s claim – $28K, insurance paid $2K. Hospital’s claim – $98K (I don’t know how long his stay was or what it was for), insurance paid $7K. That’s $117K that he was responsible for. Seriously?!? What’s the point of even having insurance? Great. Fun times. Am I going to have to start some web site directed at people with amputee fetishes and charge for “peep shows”?!?! I kid, obviously. Ick. But, I mean…come on…
Next steps – get procedure codes and speak to billing department of doctor/hospital. Speak to A Step Ahead and see if they have “back-up” docs that are in-network for me….
I liked it better when a doctor would just come into my room and tell me we would be going into the OR in a couple of days and then on that day someone would come and wheel me into the OR. This is going to be surgery #13, but only my first time having to deal with all that goes with scheduling surgery. As if having surgery #13 isn’t stressful enough…