Day 105
The insurance company outright refused my surgery at Alta Bates/Summit. They said my "contract" allows me to go to one of two places in Northern California -- either Valley Care in Pleasanton or UCSF -- and the AB/S staff shared with me the news that the surgeon at UCSF just quit.
And before you ask, yes, I asked if there was any possibility of an appeal. The answer was a very direct "no." It seems crazy to me -- the surgeon's covered and the hospital's cover, but even thought they're a certified Center of Excellence (COE) for Bariatric surgery, they're not explicitly called out as approved in my "contract." (big SIGH)
The only upside is that the surgeon that started the COE at Valley Care in Pleasanton is Mary Estakhri and I met her 12 years ago. She was an awesome surgeon then and likely is even better now. I had a fortunately benign breast tumor that she removed for me back then, doing such a great job that you can barely see the scar if you know where to look. Unfortunately her reputation precedes her and she's booked for new patient intake visits all the way until 9/16 -- 6 days after I was hoping to have the surgery. I spoke with her assistant and she is going to try to get me in earlier -- hopefully I will know tomorrow.
I have to see the VC COE nurse and nutritionist also before I can proceed. Thankfully there are openings to see them this Thursday afternoon so I will do so then. Hopefully those are the only repeats I’ll have to do. Best case scenario I think I can hope for now is October or November surgery again... I hope my original December target doesn't become reality.
I guess there is one more upside -- that is that this is so close to home -- no more trips to the big, bad city.
On a different couple of notes -- best news all day: I have been officially discharged from wound care treatment and am officially designated as healed. The skin is very tender and I'll have to be careful, but else-wise all is well.
I have officially survived one year with my employer now as of today too -- something in this economy that I can say I am very happy about. I am hopeful that things will continue to get better and all of us that want to work can do so.
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At first I thought that the surgery had been denied before I read the whole story! Close to home is good, especially since you know the surgeon in Pleasanton. Health benefits are whacky, so confusing it takes a team of pros to figure out what is, or is not, covered under a specific plan. Sometimes things happen for a reason we don't understand, and maybe this will end up being a good thing?
ReplyDeleteThe good news is that you can schedule a date, and maybe some other person will cancel for unknown reasons, stepping up your date?
That your wounds are healed is great, I can't even imagine how painful they were for you. Yay!
Also congrats on keeping a job for a year, especially at Robert Half. Having an income is a good thing, life gets pretty scary when there's no money coming in....
Thanks Susan!! Indeed you're right -- maybe this is "meant to be" -- argh! :)
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