An Insurance Snag

I hate doing things last minute.  I'm a planner and enjoy planning until kingdom come.  But it seems that life (ahem, Jesus) has put us in the precarious situation we are currently in.  Obviously, He wants to be glorified through this whole thing because, get a load of this .....

We scheduled surgery about a month ago.  Dr. Fearon turned out to be our of network - OK, not so bad, not so bad.  His fees come to about $10,000.  I don't have that, but I can raise that (thank you previous missionary work).  But that would be all me and my effort.

So now, our insurance wants to deny the whole claim because we haven't gone through an in-network PCP to and in-network surgeon.  We would owe all of our fees up front if we choose to go the self-pay route.  All $43,101.00 of them.  Now, I get it .... insurance companies have an algorithm and there are certain providers who fit into that.  They then participate with UnitedHealthcare and UnitedHealthcare knows they are providing the best care within their guideline.

When you need a specialist, your in-network PCP can suggest another in-network specialist and again, United Healthcare knows that new specialist is totally kosher with all of their rules.  Great.  Find another in-network specialist.

Well, our story looks like this .... go to the wrong type of specialist from a non in-network doctor who doesn't participate with any insurance, get the incorrect information.  Finally schedule with a neurosurgeon under a different insurance that doesn't require referrals for specialists.  Move to a new insurance in a new state and see a whole host of non-network doctors that we pay for completely out of pocket to try to treat A, then attempt to integrate all of those medical records into a system that we have not been conforming to for about five years (that would be the children's pediatric insurance system).  And you get the following challenge:

We didn't start this process with an in-network doctor.  We didn't stay with and in-network surgeon and so we don't get coverage that we need. 

Now before we grab our pitchforks, let's just look at this from the insurance perspective.  They don't know if my non-in-network PCP is a quack or even a medical doctor (she is, FYI), so when she authorizes me to see someone, it doesn't mean much to them.  Furthermore, they don't have any sort of data on Dr. Fearon and it would take them a bunch of extra time to figure that out.  They ARE a private company, needing to make a profit, so that people can have jobs and our economy can continue to eek forward.

Soooooooooooo, we need to be able to 1) get a referral to an in-network surgeon, 2) get a second opinion from them, 3) weigh whether or not that surgeon is a better fit for us and 4) if they are not, write a very informative appeals letter about why the in-network surgeon is not as qualified to do the surgery on Azelie as Dr. Fearon.

And all of that basically has to happen by tomorrow afternoon.  Right. 

So, unless a ridiculous number of things - which I am prepared to at least attempt - fall into place in the next 48 hours, we are probably going to have to re-schedule.

Now, rescheduling isn't the end of the world.  But I do have another daughter who also likes her schedules.  She is prepared to get on a plane on the 22  (March 22nd, that is) and I think she might just drive herself, if we don't take her :)  Also, my saintly mother is coming with us and has taken the week off work.  And I've just planned about a ba-gillion things for the week of March 23rd!  So please join me in praying for a miracle of bureaucratic might that the insurance company magically files it's paperwork quickly (me calling them every hour probably won't hurt either :)

Pier Girogio Frassati  - dude, we need you!  Pray for us!  And have a drink for me because it's Lent down here.