Shrinky Inky

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Making them and hearing the phone ring is now making my stomach rumble and get tied up in knots!!  This is no way to be.

Called Insurance again...got through to someone with compassion and she gave me the actual name and extension of the nurse reviewing my case. 

Called and left a message.  Cross your fingers.

I have been having dreams the last few nights, alternating approval and denial of surgery.  I woke up today feeling really defeated.  I can only hope and pray that I am approved.  Because of the misinformation provided by not one, but TWO people, at my insurance company Carefirst BCBS PPO out of Maryland, I really feel like giving up. 

I know this will pass, but it's just how I feel right now.

It's been a month tomorrow since my consult, it took the doc's office 17 days to submit my paperwork to insurance, and they've been sitting on it 12 days now.  yea, not so fun.

I expect I would hear SOMETHING this week.  Right now I just want an answer, this up in the air feeling is killing me.

ugh.

Only because I will laugh about this later...

Yesterday i get my "explanation of benefits (eob)" from my insurance.  it's for the consult with dr. f and they denied it as out-of-network, although i had checked to make sure, both online and on the phone (fat lot of good phone calls are) that he is in-network and the office also confirmed it.  the funny thing was it said the providers name was "vogel" with an address in san leandro. 

so i call dr. f's billing department.  no, they don't bill as "vogel" and i should call my insurance.  oh yay. 

so i do, and i talk to someone that actually sounds intelligent and he gives me the provider billing number and says to call back the doctor and give them that.  i figured, hey, this Stan guy, he sounds like he knows his stuff, so i start talking to him about the whole approve/preapprove/in review thing.  he confirms it's in review, not approved, and apologizes for the errors of Mr. Thompson and Lashawna.  okay, i'm down with that.  then he says something magical....

would you like the direct number to Utilization Management so you may speak with them?

wow - a phone number.  to the department reviewing my request? from the insurance people? that's like the holy grail!  (no one would give me that before, even when i asked.)  yes, of course, and oh, thank you, you'll transfer me directly, you are very kind, Stan.  have a nice day.

i get to a gal that says, yep it's in review, you should get a letter (that's news) and we'll call your doc's office too (ok i don't really believe that, but whatev).  and you can call back wed or thurs next week, it should be done by then.

call you? directly?  yes, ma'am. 

well hot damn, now we're getting somewhere.

oh, and dr. f's billing department called me back after researching it and my insurance had their info all messed up and she is re-billing them. 

I think not!! Here it is, seven days after my insurance (two different people) first told me I was approved.  Yesterday I called Carefirst again and this person said there is a "pre-approval with a tentative admission date of 4-26-2007 and release date of 4-28-2007."  So I asked if they had notified my insurance, the rep said, "No, they have to contact Utilization Management to get the approval."  Which, coincidentally was the exact same thing the other two Carefirst reps told me last week.

I figure hey, let's call Dr. Felix's office.  The person I spoke to was not listening, and just giving what sounded like a speech (i'm sure they get LOTS of impatient patient calls!).  I let her finish and tried to tell her again what Carefirst had said.  She told me lots of people have Carefirst and they always send a fax for approval.  When I was there in the office in person on the 27th of February, I was told they'd only had one client with Carefirst and it had been approved, but she could not recall how it went.  So, it ended up that they would call Carefirst and call me.  By Thursday.  We'll see......

edited to add:

Thursday 3:05 pm - no call (did i think there would be one - of course not).  After more unpleasantnesses with the phone clerk, i get through to the scheduler, who did indeed call my insurance and yes, you are right, Ms. Inky, we have to confirm with them (yay, vindication!).  But you are not approved yet, it is in review.  Okay, fine, sigh.  now what?

Well, she says, call them in a week and follow up.  Sigh, blah blah blah, yes okay, thanks.

Let's see, they've already told me i'm approved and now you're asking me to call in a week so they can tell me that again.  sigh. 

I am going to sleep on it, call the doctor's office manager to report the phone clerk for her rudeness two days in a row, and then call insurance, again. 

i love a good bureaucracy, don't you?

I found a local support group recently and attended a monthly meeting today.  Nice folks, all ages and stages of WLS.  There was a tremendous amount of information, both verbal and printed, and I left feeling pretty good.

I was the only one using Dr. Felix, and everyone has opinions about their surgeons, you know how it is.  I figure if I reviewed their record, felt comfortable with them, and their office, then I am in a good place.  One person has had a bad experience since her surgery with a stricture and had several weeks of pain and discomfort, but is now back on track.  There were three of us pre-op, a couple people several years out, and one six months out, so it was a very good overview of what to expect at different stages.

I am glad I found a good group in our small town, so I will go back.  I think a support group environment can not only be informative, but also give me accountability, especially down the road.

I wished I had something different to think about while i WAIT WAIT WAIT for approval - the the powers that be gave my husband Bell's Palsy!! He'd been complaining of neck and head pain since Sunday, and it wasn't getting any better, but it was tolerable enough for him to not miss work. Yesterday when he came home from work, he asked me to look at his face and, well, it was kind of scary and not in a good way. The left side of his face was droopy and puffy looking. Immediate thought - stroke, but his arms and legs were fine, and the pain was limited to behind his ear and eye.

Off to the emergency room, as by now it was 6:30 on a Friday night.
So after the check by the nice doctor lady, she tells us all about Bell's Palsy.   We'd never heard of this before, and it's pretty common, actually. The good news is that recovery is good, but long. Also good is that we did not wait to bring him in, and started his steroid/antiviral meds right away. Bad news, scary business about your eye during a Bell's episode where it can dry out and have cornea damage. So it's lots of drops and eye ointments for Mr. Inky. He does have some localized pain, but not bad enough for pain meds, and he can't take motrin/aleve/aspirin/tylenol while he's on the steroid, however, nice lady doctor said the steroid should alleviate any pain fairly quickly. Personally, I can't stand prednisone, even though it does work. I was on it for 3 courses one year, the last one taking several months and puffed up something fierce. Hopefully one short course will do it for Mr. Inky.

Also good, he's wearing an eye patch at night. And nothing says sexy like a guy with a pirate beard and an eye patch. As long as you don't mind a droopy face! So say some prayer's for Mr. Inky's quick recovery, if you could.

I called Dr. Felix's office today and the transcriptionist is not back from vacation for at least a couple more days and hasn't sent out anything since last week (and i quote "yep, there's a big stack of files in her office waiting for her."), so no point in worrying.  I will officially start "waiting" next week, lol!

ok, onto something to keep me busy until then....

So frustrating the waiting game for approval.  I try not to think about it, but just can't think of anything else!!

Keeping busy with work, which is typing probation reports for a large metropolitan city in California, always interesting the way people throw their lives away in search of the next high/theft/assault/or worse. 

Had a dream I walked into surgery naked, except for the exquisite lace shawl I was wearing (i like to knit).  I'm not sure what that dream means yet....but I don't think lace is appropriate surgical wear!!

tick tock...wait wait...

Hey, all you people dogging Fresno (including me), well, it wasn't so bad. People were really friendly, drivers appeared polite enough and the trip was perfect.

I had great company in a dear friend who used to live in the area. She drove, thank goodness, cuz I hate the driving! Fresno is about 3 hours away from us here on the Coast, on a treacherous road, part of which is the place where James Dean died. Not quite the "dead man's curve" i envisioned, but interesting just the same.

My first appointment was with the Nutritionist, for a seminar on eating after surgery. It really put my mind at ease and was very informative. The part where she held up the TINY one ounce medicine cup to illustrate the size of your new stomach pouch after surgery was shocking, even though I knew what an ounce was.

I met with the doctor for a brief check up (basically to make sure my parts are in working order and located in the approximate appropriate places). The office now has all the necessary documentation and will submit to my insurance either this week or no later than next week. After that is is approximately two to three weeks to hear from insurance, so I need continued positive thoughts, prayers, candle burning, insurance voodoo dances, etc. By the way, Tina asked what color candle, and I've been burning white, charged with good positive thoughts and imagery of me going through the surgery successfully. I really believe in the power of positive thinking, and this will be approved and will be happening SOON!!

We decided it would be good to check out a few hotels in the area, as we have to stay 5-7 days after surgery. Wow, what a difference - the two sort of generic and not that great motels right by the doctors office were among the most expensive (even with medical discount). We found a lovely Residence Inn, but at $165 a night, even for a one-bedroom suite with kitchen, a bit pricey for our budget. We found a really posh, well-decorated Holiday Inn Express about two miles from the doctor, with a flat screen plasma, small living room area, tiny fridge and microwave for $119, and then a Marriott Towne Place Suite, 1 bedroom, full kitchen (micro/oven/stove/fridge/dishwasher), for $79 a night with the medical rate. WOW! sold and hopefully they will be available when I get my surgery date.

Following our eye-opening hotel crawl we found a nice salad bar place for lunch and fueled up, headed home and made a small stop in Atascadero at one of my new fav LYS - The Scarlet Skein. If you are in that area do stop - it's small but nicely packed with lovely yarns. A skein of Suri Elegance in a gray/plum color way somehow came home with me. Yarn diet be damned!

Finally, I want to thank my Mom and Dad - they have come through again and are fully supportive of this surgery and generously gifted me some money to help defray some of the expense. Thanks, you guys never cease to amaze me with your love and support!!