The Story Behind The Insurance Denial

At least as it currently stands…

I’ve been talking to a variety of offices and people since finding out the insurance company denied all charges related to my visit to the ER and the emergency procedures and surgery. I’ve been more than a bit interested since first finding out that it was because of lack of prior authorization. There may have been a bit of intimation at one point that I should have called them for permission to go to the ER, but I’m told now that such was not/is not the case.

If the information I now have is accurate, the hospital did indeed file all the right paperwork with the insurance company in the appropriate time limit. However, they initially faxed it to an incorrect phone number. Once the wrong number was discovered, they resent it to the correct number. However, that was the next morning, and as such it was “late” and so the insurance company said no to all bills.

As for me, I am curious: did the hospital send it to a truly wrong number, or had there been a number change? Given the amount of business done with the insurance company, I have to wonder how they had a wrong number. If it was a change in numbers by the insurance company, had that been communicated to the hospital? The one thing I will say is that 99 out of 100 calling the number for the insurance company is about as useful as teats on a boar. Finding out that it’s not just my luck in calling and getting someone who doesn’t want to do a thing — they apparently are notorious for ignorant, ill-trained (or flat out untrained), unhelpful phone reps. If you do call them and are hitting walls, just try asking for a supervisor, as there is NEVER one on the floor/available at that time. Don’t hold your breath waiting for them to call back, either.

The good news is that several parties are appealing this denial. I’m holding up on my appeal until I talk with at least one more person, as what I may do is appeal (for now) just one particular denial if it can be coordinated to and help with the appeal by the provider.

For now, going to continue not naming the company. If all appeals are denied, however, the gloves likely will come off and I will do my best to call in the world. Meantime, at least some stress is off knowing that appeals are in process and others are working on their and my behalf on this. Hate that I’ve already got one bill as a result, but will talk with them next week and probably send a registered letter just to be safe. From what I’ve been hearing, even though one or more appeals have already been filed, it will likely be a month before we hear back on them.

Slow But Steady, And Very Frustrating

On some levels, the recovery from the surgery is not just amazing, but bordering on the miraculous. As I think I’ve noted before, there has been very little pain. The nerve blocks and drugs that blocked the nerves worked wonders, and long enough to get past the worst of the first. The plates in my chest are the other major factor, as they keep the breast bone together and make it where you have to work at it to have discomfort or pain. You can do it, but it takes effort — thank goodness.

Getting back to normal activities has been rapid in some cases, and incredibly slow in others. My ability to look after myself and do normal living things (bathroom, cooking, etc.) progressed very rapidly once I was out of the hospital. On the other hand, doing physical activity of any kind, is slow. Part of that is just I can’t do what I used to do. Part is because despite this there is a temptation to push and to try to do too much too soon. Part is that even when I should be clear to do more, it’s not happening so as to help prevent me from doing too much too soon.

That makes rehab and other exercise activities intensely frustrating on more than one level. That said, I’ve also experienced once before what pushing too hard too soon gets you, and have no desire to ever repeat that. So, catch myself having to pull back more often than I care for. That’s particularly true for walking, as I need to keep my pace down for now. And, yes, I’m actually coordinating my off-day walking with the good folk at rehab so that it complements what we are doing there (though I would just about kill to add some upper body work).

I will also be honest enough to admit that while I have bounced back a surprising amount, I’m not even close to where I need to be, much less want to be. I do great in the mornings, get things done, do my walks/rehab, maybe run some errands even. By mid-morning to noon, well, the charge starts to go out of the battery. By afternoon, well, I’m sorta toast. Six in the evening often finds me starting to head to bed, though I try to stay up until eight. This is why I wish the paperwork for rehab had not had issues — the more I rehab and exercise, the more I will bounce back. It just takes time, and it really does take sticking to the schedule I regard as slow. Me impatient? Never!

The drawback to all the activity is that, not unexpectedly, has kicked off a couple of things we need to deal with. Foremost among them are BP issues. Since BP issues were the first issue after the lightning strike, I really want to nip them in the bud. It looks like we have some progress starting on that, will take another week or three to see if we do have it dealt with. Until that is dealt with and I get some stamina back, I will remain out of work. Right now, given the path of rehab and such, looking more like February at the earliest. Anyone wants to hit the tip jar, feel free, but there is more news coming soon. And, yes, there are a few other things we are having to keep an eye on other than the BP. Surgery can, and has, done a lot. However, it can’t fix everything and one thing about lightening survivors is that both cardiac and neuro issues can crop on a long-term basis.

Which leads to some of the weirdest issues post surgery. First was a change in taste that continues to dog me a bit. Not long after surgery, ate and drank some things I normally like (in some cases, really like ALOT) and all but spit them out. A couple of drinks tasted like a mix between lighter fluid and washer fluid. A couple of meal items tasted like salty bitter decomposing leaves. Couple of other odd taste sensations, but those stood out. Some of that has moderated, but really notice bitter/salty tastes much more than I used to. Have even had to modify my coffee making to adjust to those changes.

Second, Mr-Never-Feel-The-Cold here is feeling the cold. Along with pressure changes and humidty changes, this new feeling of the cold has done a number on me and my arthritis. It also effects breathing and more. I’m very thankful that we’ve had a mild winter so far, as the few real cold days have been brutal. One reason I’m having to do as much mall walking as I’ve been doing is that I’m not supposed to walk outside if it is 45 or below. That can cause bronchial spasms, and those are unpleasant. Heck, if it’s 45 or below, I am not enjoying being outside period, and waiting for the car to warm up is less than fun (actually it can be miserable).

So, progress is being made. Just slower than I would like, though in many ways it is going better and faster than I have any right to expect. Meantime, need to look at some of the other issues going on and make some decisions. One thing I will not do is try to rush things, for that way lies madness and a much longer recovery. Crazy I may be, but stupid I do try to avoid.

More soon.

An Update

Sorry for the lack of posting, but it has been interesting. Some good, some, well…

On the good news front, I’m continuing to heal well and fairly rapidly. I’ve been remarkably pain free, and a good bit of that is because of the metal plates put in on my breastbone. They prevent a lot of movement and stress, which eliminates pain. There was a paperwork hangup with cardiac rehab, but we finally got that cleared and I did my first week of rehab last week. Going well, though slower than I would like. Of course. Days I’m not doing rehab, I’m going to a mall and walking before it opens. Accidentally got there after opening one day, won’t make that mistake again.

On the so-so front, blood pressure issues have returned along with a few odd sensations that we are monitoring. Want to get out in front of this to prevent any issues, and to avoid what happened the last time the BP did funny.

On the not-so-good front, my insurance company has just sent my BP through the roof. Last week, I called and spoke with a knowledgeable, helpful, and friendly representative about cardiac rehab and coverage of same. They had not received something they needed, so per her instructions I reached out to the doctor and then called back this week. The rep had put a note in the system on the issue that should have made things go smoothly. Sadly, I tend to get the good reps only about a quarter of the time, and this morning I hit the far more typical unhelpful, unfriendly, uninterested in doing anything. Apparently could not be bothered to read the note, told me that the rehab people would need to call them, and made clear that they could not and would not be bothered to actually provide help. When I asked to speak to a supervisor, was told that none were on the floor. When I pushed, was informed that if I gave her my name and number (both of which she already had) that a supervisor would call me “at their earliest convenience.” Now, add to this that I also found out that the have denied all claims related to the ER visit, the heart cath, and the open heart surgery because apparently there was no prior authorization before I went to the ER (and maybe I was supposed to call before each of the urgent/emergency procedures???). Very tempted that if I keep getting the run-around, will share the name of the company and anything else I can here. Figure if I’m going to be put on the hook for app. $350,000.00, that I should share the comedy gold that is trying to get customer service out of these people.