[mj2903]

Actually I work at an insurance company, but I don't like dealing with unknowns and this is beginning to feel like one big unknown. A couple of things happened today.

The case manager from my primary insurance company called today and talked to my husband and told him to have me call my surgeons office. Fair enough, but the person that handles my account there is on vacation (and I am not a patient person right now).

In addition, I called my secondary insurance company as they are the ones with the good benefits that I need to afford the surgery and they informed me that they will not review the paperwork because they are secondary. They do it as a consideration for their primary insurance clients but not when they are secondary.

So basically, if my primary insurance denies, I will have no idea if I have coverage until after the surgery is completed, and if they do approve, I could still end up paying well more than $10,000 more than I planned if my secondary decides not to pay. Why no one told me this the other half dozen or so times I called them I don't know.

I prefer things to be more concrete, I do not like ambiguity especially when this procedure without complications is pretty pricey let alone with complications.

I don't want to believe that God has led me this far to not go through with this, but I am afraid that if I have complications, I will end up having to file for bankruptcy because I don't have access to that kind of funds.

Anyone else have a similar situation?

[SummerBreeze]

Wont your primary insurance cover things if there is complications ? Guess I am not quite understanding, but good luck ! As far as your surgeons office they will make sure who is paying what , they want thier money so they make the calls and do the paperwork and let you know just how much coverage you have from whom before the surgery, so you can decide if you can afford it...at least mine did...again good luck !

[mj2903]

My primary insurance company caps their coverage at $15,000.

[SummerBreeze]

OUCH !!! ,I dont want to scare you and I do know I was the exception to the rule , but 8 days in hospital and last we adeed up its 90 grand , we just quit adding it up finally...but i had alot of health issues going on , and was in ICU for 3 days...I do know most are in and out in matter of days...also I had massive scar tissue and had to be cut wide open , and healing from all that has took alot of time...good luck..the unknown is very scary for sure...hopefully you dr office can get hold of secondary insurance and see where they stand on it..I cant imagine some one cant answer that

[mj2903]

I hope so, the gal that is handling my account should be back tomorrow, I can't believe that with this kind of money on the line, the insurance company won't review the paperwork ahead of time. I even pointed out that if they didn't cover it with the minimal coverage from my primary insurance that it could force me into bankruptcy.

I am very aware of the risks of surgery and complications and am still trying to make sure that we get the benefits we deserve for hubbies fight with his barberry plant that landed him in the hospital for 11 days, surgery by what we were told is the best hand trauma surgeon in the country, daily therapy at the hospital and in home health care with iv antibiotics every 6 hours for probably at least 4 weeks. As long as the hospital gets the referral information to the insurance company we should be good for his hospital stay, just a straight co-pay. the in home therapy is a ppo provider so covered at 100% as are the iv antibiotics, the main item we are not sure of is the therapy which is probably covered at 80% which is still good, but maximum of 30 days and he still has a huge incision although it is closing faster than I expected.

Needless to say I am a bit spooked, who would have thought a thorn and splinter would nearly cost him is arm or even his life. So, although I hope(as everyone does) I don't have the issues that you did or that others are currently experiencing with infection or even repeated strictures, I understand there is always the risk.

BCBS of AL even told me that they don't have to pre-approve the surgery on their primary patients...that they just do it as a courtesy to them. I may have to pull the 'my husband works for you' card and have him call and get 'bitchy' to get some answers, just hope he doesn't take his pain pills first.....never know what he might say...

In the meantime, I am praying for direction and patience and the faith that God would not have brought me this far in the process to have me quit now.

[mj2903]

Well, I did get the approval from the primary insurance and now have my surgery date. They had been scheduling 2-3 weeks out, but wouldn't you know it's now August, but I asked to be put on a wait list if they have any cancellations.

The surgeon's office didn't get any farther with my secondary insurance than I did so will be praying until I find out if they actually pay that they will cover it. I have a paranoia of going through with this, having a lot of complications and his company denying the claim even though we did everything that they had listed in the requirements.

I really had expected this to be much more of an exciting milestone instead of the stress it is bringing by not getting the official good to go from BCBS AL.

[mj2903]

Well, I did get the approval from the primary insurance and now have my surgery date. They had been scheduling 2-3 weeks out, but wouldn't you know it's now August, but I asked to be put on a wait list if they have any cancellations.

The surgeon's office didn't get any farther with my secondary insurance than I did so will be praying until I find out if they actually pay that they will cover it. I have a paranoia of going through with this, having a lot of complications and his company denying the claim even though we did everything that they had listed in the requirements.

I really had expected this to be much more of an exciting milestone instead of the stress it is bringing by not getting the official good to go from BCBS AL.