Insurance SNAFU's & Recovery
*UPDATES*
5/30
6PM
Tony's recovery is going swimmingly well. We have LOTS of follow-up appointments coming, including another CT scan on 6/7 where doctors will assess removing the drain he still has in place. (If the CT is favorable, he will undergo a small surgery for removal directly after that appointment.) We need that scan to be crystal clear and not alerting to ANYTHING new that may require yet another surgery.
Nurse Nelson is still tending to drain flushes and trying to reign in the "work-horse" that is my husband who thought staining the deck would be a good "endurance excercise".
He got "permission" to hit some tennis balls, and so he has been working on that and regaining strength. (He's asked me to "hit" with him, but I've officially quit tennis... for the 479th time. I'm serious this time.) Each day is an improvement for him. His goal is to ease back into work at the tennis center, starting on the 12th of JUNE, and doing a 20-hour work week, then a 30-hour work week, then back to 40. This all feels like a miracle to me. Seriously. I am in awe. God is good, and Tony's resilience is inspiring. I think the days of 60+ hour work weeks are gone. We need our husband and dad home more. There is nothing like a true wake-up call to realign your priorities.
We need some prayer on our latest hospital stint. Our insurance is denying ANY coverage after 2 surgeries and FIVE days of stay because they claim it wasn't medically necessary for him to be admitted. Keep in mind we were told to head to the ER immediately, and we asked MULTIPLE times if we could leave and come back. We were told "no" EVERY time. He was "bumped" for surgery for over 2 days. He was medically stable, however, so our "claim" is denied. We go to bat tomorrow to try and appeal it. We did EXACTLY what MULTIPLE doctors told us to do, and they ALLLL said we could not leave.
Ezrah (whom this blog was originated for in September of 2022) has left leg pain back intermittently, and she has a follow-up with orthopedics (Dr. Bob) on 6/5. (That will be a busy week of traveling to Portland for us.) She will most likely have imaging to see what the osteomyelitis is doing.
I have attempted (and failed) MULTIPLE times to write thank you cards to everyone who donated to our Give Send Go, or brought a meal, sent cards, flowers, gifts, etc. I can't keep up. Please know how grateful we are. We don't know the bills coming down the pipe, but we know that being off work for over 2 months was NOT ideal, but necessary. I wish I could send a thank you card to each of you. It's how I was taught to express gratitude. But, I'm beautifully overwhelmed and really trying to focus on our family time that is quickly fleeting with the countdown to getting Tony back to work. But, admittedly, I'm losing sleep over it. I am just so grateful. We all are.
Thank you for going to bat with us in prayer. We know it will all work out, but it sure is a HUGE load to carry right now.
But ya know what? He's alive, HE'S ALIVE. And we are full of gratitude.
And...Luna Lovegood is home. 💜🐶
Get letters from the drs that forced you to stay!!!
ReplyDeleteGood plan. There were a LOT. I need to dig through his med notes and find out all their names.
DeleteAbsolutely!
DeleteYou have your work cut out for you, but you can get this covered! I just can’t believe after all of this that you can possibly be denied coverage….
Amy Fleckenstein
ReplyDeleteI'm so sorry you have to deal with the insurance crao. I can relate to how confusing and overwhelming and awful it is...and I worked in healthcare for 10 years!! We STILL battle stuff, even after 8 years af dealing with all this. If things don't go well with the first appeal, reach out to me and I can give you some tips. Which insurance carrier do you have? Also, I learned early on in our journey that thank you notes were never going to be sustainable. Please let that guilt go. A friend "gave me permission" to do so way back when this started for us and it has helped me so much. We send love and gratitude and promise to pay it forward as we are able. And that's the best we can do. So I hereby give you permission to knock that "thank you card guilt" to the curb! You're welcome. Lol. Take care, sweet friend. Reach out if you need help with the insurance stuff.
Oh Amy. Thank you. We have United Healthcare. Gosh, sure appreciate your sweet words. I know you walk this daily. You inspire me and so many others. I'll let you know hot it goes. I'm still working on the appeal.
DeleteI think the lovely updates and blogs shows your appreciation and care . As you didn't have to do that . We all know that focusing on your family is most important right now .
ReplyDeleteBless. 💜
DeleteMake sure in your appeal that you request the notes from their doctor that stated it wasn’t medically necessary. Saw something on YouTube where insurance companies just send their a doctor a link to approve or decline and don’t send the actual medical file to review. A doctor had his declined and he spent 8 months challenging the insurance because he knew it was medically necessary and that’s when he found out the doctor’s signing off for the insurance aren’t actually getting files to review (that takes too much time). The insurance companies figure most people won’t appeal or keep fighting.
ReplyDeleteThe doctors never said it was medically unnecessary. The insurance did. :( So frustrating. I'm definitely appealing it!
DeleteYou should be able to see all the doctors that treated Tony in the Epic MyChart app. If you need any help let me know. I'm at the tennis center everyday but I have to take Aiden over to Wenatchee today and will be back on Monday. I can also show Elijah on Monday to on how to find all the doctors.
ReplyDeleteThanks, Paul. I have been going through the notes in Epic from that stay. There are just SOOO MANY different people he saw. And sooooo many notes. It's a lot to cipher through. But. I THINK I have found all the names I need. Thanks for your help.
Delete