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Tbone

Tbone

Well-known member
Joined
Feb 14, 2009
Messages
907
Location
Canton, OH
Well here I am in a holding pattern yet again. On April 23rd I had a four-way catheter with a few weeks to heal. On May 29th I had a hernia operation with a few weeks to heal. I had an appointment at the Cleveland Clinic set for Monday July 6th with the surgeon & my doctor. That?s right for my third heart (not including my two ablations or other procedures) surgery. WELL on Thursday July 2nd that got canceled, and I was informed that the surgeon requested another catheter.

Now as you can imagine I am, at this point, highly :mad::mad::mad: agitated that I spent 8 ½ hours on the table with a catheter. Yes this was to search for & repair some of the cyanosis of my left lung. Yes some of it got repaired but I have yet to notice the difference. I was on the table also to have all my valves let alone my 32 year old Hancock valve checked. Also I was to have all my pressures checked and the likes.

Because I was put under & on a ventilator the surgeon states that the pressure readings could be off. He wants accurate pressures so he may decide how to proceed, during the surgery, if any ifs & what fore?s come into play.

This whole time I?m thinking good luck getting this approved with the insurance company. It will take me years to pay it off myself.

Russing fussing cussing little cockroach :mad::mad::mad:
 
I'm a little confused what are you trying to get approved more testing? another cath with out a vent?
I hope it all works out as easily as possible. FWIW We have BSBS and as Justin has had more and more surgeries, we've never had any problems getting mris, caths ect approved I hope you are as lucky
 
Lynlw said:
I'm a little confused what are you trying to get approved more testing? another cath with out a vent?
I hope it all works out as easily as possible. FWIW We have BSBS and as Justin has had more and more surgeries, we've never had any problems getting mris, caths ect approved I hope you are as lucky
Click to expand...

I had a catheter done on April 23rd. Now they want another one only 11 1/2 weeks later. When you are asleep under medication, and vented the air is forced in & not drawn in by the diaphragm. This therefore changes the pressures in your lungs & heart. The surgeon wants actual pressures before the surgery. Also this is out of network.
 
Tbone said:
I had a catheter done on April 23rd. Now they want another one only 11 1/2 weeks later. When you are asleep under medication, and vented the air is forced in & not drawn in by the diaphragm. This therefore changes the pressures in your lungs & heart. The surgeon wants actual pressures before the surgery. Also this is out of network.
Click to expand...

That makes sense, Justin usually wasn't on a vent for cath, unless he was already on a vent ..if that makes sense.Since this would be done with out a vent it should be considerred a different thing so they shouldn't have problem approving it. Justin had several caths with in the first couple years he was born, with out any problems
The out of network can be tricky, but the "good" thing about having multiple OHS, is from MY experience the companies have been pretty good at approving out of network, to go to the places with more experience. Again I don't know who you have, but most of Justin's surgeries were out of network but they were pre approved. Actually for BCBS when we wanted to go to Boston for 2nd ops ect (we live in south NJ) we were told as long as the hospital was in network for people who live in that area, they would cover it as in network and we didn't have any charges except for the usual 20 dollar co pays.
Do you go to an adult with CHD specialist? if so that may help with the arguing.
 
TBone...... Hope you don't stress about the approval in advance. You may be pleasantly surprised they approve the second cath without argument and you would have suffered stress for naught. GOOD Luck. I hope everything goes smoothly for you.
 
He's got the same insurer I do and it'll be lucky if they approve it. I have a feeling he's going to have to appeal his butt off to get this one covered.
 
Dealing with insurance is no fun and neither are caths, but I do wish you the best, though, and don't worry about being a fuss. I fuss all the time. ;)

Best,
 
T-Bone, I hope there is some way you can get this covered. This is so stressful for you, I'm sure.
Good luck.
 
feel your frustration.....always a struggle isnt it,(prayers for you)
come on in your welcome to vent somemore,at least its's free
and helps some.Hang in there with us.

zipper2(DEB)
 
T,
I share your indignation at the stupid freaking healthcare we have in the U.S. If you need a procedure, you should be able to get it..period! Mad at the system too! Hope you get what you need.
 
COLLEEN S said:
T,
I share your indignation at the stupid freaking healthcare we have in the U.S. If you need a procedure, you should be able to get it..period! Mad at the system too! Hope you get what you need.
Click to expand...

Just wait till Obama gets done with it. Socialized medicine at it's best we'll have to wait 6 months for an echo.

Well, I was told by Cleveland that it was covered, I'm going to call my charier Monday to make sure. :)
 
i am canadian and although there are some things that you do have to wait for like an m.r.i. i have always found that if your life depends on it then you will get the help that you need as soon as possible. i have lived in both health care systems and although there are drawbacks to both systems i would still rather have the one in canada anytime. where you don't have to worry about what hospital is covered by your insurance and you don't have medical bills coming in when you have so much more to deal with. where you can choose any doctor you want. it is a big misconception that kind of healthcare system isn't as good. there is drawbacks to any healthcare system. but IMO, one where you have the freedom of choice without having to worry about whether something is covered is a big plus.

anyhow so glad that your second cath has been approved. hope they find out what they need to so you can get your surgery as soon as possible.
 
didn't offend me at all. that was my opinion also. after living under both health care systems you kind of get the idea of what each is like and as long as the health care problem in washington is done right it should be better than what we have now where there are so many people that are without health insurance that can't go to the doctor and end up in emergency rooms when something is seriously wrong which we all pay for anyway.
 
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