Yesterday was supposed to be my 'excitement day' at my Plastic Surgeon's office. Finally... the skin seemed to be healing and I was hoping we'd just get back to where we are supposed to be... filling the turtle shells in my chest! (for anyone wondering why I refer to the tissue expanders as 'turtle shells'... it's because they are hard and clumpy and totally unnatural feeling). Anyhow... aside from a little oozing/bleeding on Easter Sunday... things were looking pretty good! Then the mail lady came on Monday and there it was... I almost couldn't believe my eyes... a BILL from the PS office. A BILL that we thought would be covered by our insurance company. And once again, for me it was into the 'around and around' telephone calls to billing departments and insurance company reps... all of whom seem to have no HR skills.
The story now seems to be that the insurance company, who assured me when I did my due diligence in inquiries, that Dr. Miles is an 'In Network' provider (this means that any billing from her would be completely covered by our insurance once we paid the individual deductible and met the cap on out of pocket expenses (which we bypassed months ago) up until the year end calendar date which for us is May/31/09). But now... according to Dr. Miles' billing department, she is in fact 'Not In Network' with our insurance company.
And this is where it gets convoluted... Dr. Miles is a provider with Insurance company 'B'... which was bought out by Insurance company 'A' (which is our ins. co.) and apparently because company 'A' now owns company 'B' they (the insurance company) are under the impression that all doctors that honor insurance for any of their 'sub companies' are also on board with them... I'm learning (the hard way) that this may not actually be the case. I was actually put on hold while the insurance company rep called the billing office and when she came back to me she was completely IRATE... telling me to put everything on hold until this was sorted out. Of course I still went for my appointment yesterday... and I'll go again next week. I've been putting enough of my life 'on hold'...
Trust me, I'll fight the insurance company tooth and nail and I believe I'll win! I actually had the staff in Dr. Miles' office running in circles saying 'OOohhhh... I can't stand *^%*&^# insurance companies'.... and 'go to your state representative in Olympia'... and 'get Jessie at King5 News!' :) Cheryl photo copied the 'approval letter' they received from the insurance company, giving Dr. Miles and her staff the 'Green Light' to go ahead with all any any treatment/reconstruction I needed and to this day our insurance company has her listed as an 'In Network' provider on their website. For now I'll gather any information I can to make my case... and continue to go to Dr. Miles' office for my expander fills. I was told that there is some kind of '3 Month Umbrella', under which Plastic Surgeon's reconstruction 'has to be covered' by an insurance company that approves 'breast amputation for Cancer'. That gives us until May/09/09 to finish the fills. Then in three months time (which I was told yesterday will likely be the time for my exchange surgery) I'll either go back to Dr. Miles... or to another Plastic Surgeon that actually is covered through our insurance company... that's too far down the road and far away for me to worry about now.
For today I'm going to be grateful to be back on track with the reconstruction... for having so many great people in my life that put up with all of this 'stuff' right along with me... and that my closed wounds actually dictate my being able to have an actual shower today :):)
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