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Well, folks, my plan was to tell you what a nice ?day off? I had on Sunday which I really did and how I was getting everything all together for Thursday and time is short but I?m feeling good about it all. BUT then I got a phone call from the EVIL Managed Care Department at Park Nicollet Clinic (the health insurance people) who once again have turned my world upside down.
Last Tuesday, my health insurance told me that I have NO (as in zero) out of network medical coverage except in emergencies. The only way any of the Mayo stuff would be covered was if I was referred for it by my surgeon at Park Nicollet Clinic. So that meant many frantic phone calls and long hours of waiting to hear back. My fear was that Dr. Monson (the local surgeon I talked to) would say (because of pressure not to do referrals form the insurance companies) that the Synergraft surgery was too new and experimental for him to recommend it. It was quite an exercise in self control (partially successful) to not just make myself crazy thinking of the ?what ifs? and contingency plans if this happened. I got the call from his nurse at about 4:00 that he would write the referral. I was relieved and proceeded accordingly. I even had an appointment on friday with my local cardiologist. Everything seemed all set, ready to go. I asked for a copy of the referral letter but was told it was just done by phone and computer and there was no actual letter for me to see.
The "Managed Care" people are now telling me they will not pay for the surgery at Mayo. Their position is that care is available for me here and if I choose to go elsewhere they will not pay for it. This is so infuriating (not to mention very scary) to me. So I have just canceled all my clients for tomorrow so that I can spend the day frantically making phone calls to see if I can make this happen before Thursday. If not I have to make the decision to: 1) go ahead as planned with the surgery on Thursday, knowing that I may have to pay the $70,000+ bill myself; 2) postpone the surgery to go through the appeals process with the insurance company, costing me time and income from my practice, not to mention costing me my health; 3) choose a different (far less optimal in my mind) surgery and have it here at Methodist. Yikes! Have I mentioned that we have an insane health care system? Needless to say, this is not a very healthy way to be getting prepared for open heart surgery. I guess I?ll be hoping for a miracle tomorrow so if you have any ins for helping that process I?d much appreciate it.
So I know I'm not the first or last to deal with this. Any words of wisdom or tricks for making your health care actually work to keep you healthy will be much appreciated.
Thanks for being here!
Last Tuesday, my health insurance told me that I have NO (as in zero) out of network medical coverage except in emergencies. The only way any of the Mayo stuff would be covered was if I was referred for it by my surgeon at Park Nicollet Clinic. So that meant many frantic phone calls and long hours of waiting to hear back. My fear was that Dr. Monson (the local surgeon I talked to) would say (because of pressure not to do referrals form the insurance companies) that the Synergraft surgery was too new and experimental for him to recommend it. It was quite an exercise in self control (partially successful) to not just make myself crazy thinking of the ?what ifs? and contingency plans if this happened. I got the call from his nurse at about 4:00 that he would write the referral. I was relieved and proceeded accordingly. I even had an appointment on friday with my local cardiologist. Everything seemed all set, ready to go. I asked for a copy of the referral letter but was told it was just done by phone and computer and there was no actual letter for me to see.
The "Managed Care" people are now telling me they will not pay for the surgery at Mayo. Their position is that care is available for me here and if I choose to go elsewhere they will not pay for it. This is so infuriating (not to mention very scary) to me. So I have just canceled all my clients for tomorrow so that I can spend the day frantically making phone calls to see if I can make this happen before Thursday. If not I have to make the decision to: 1) go ahead as planned with the surgery on Thursday, knowing that I may have to pay the $70,000+ bill myself; 2) postpone the surgery to go through the appeals process with the insurance company, costing me time and income from my practice, not to mention costing me my health; 3) choose a different (far less optimal in my mind) surgery and have it here at Methodist. Yikes! Have I mentioned that we have an insane health care system? Needless to say, this is not a very healthy way to be getting prepared for open heart surgery. I guess I?ll be hoping for a miracle tomorrow so if you have any ins for helping that process I?d much appreciate it.
So I know I'm not the first or last to deal with this. Any words of wisdom or tricks for making your health care actually work to keep you healthy will be much appreciated.
Thanks for being here!
