BOOMBA!

October 16th!!! I won't have to wear a mask this year for Halloween!

Communication Breakdown

I've read countless posts about mis-communication or lack of communication between ortho office, surgeon office, insurance company and patient. My recent experience is no exception.

Here's a timeline:

• My ortho, Dr. Hang, says I can schedule surgery for Sep/Oct. (May 16)
• I immediately called the surgeon's office to let them know. They asked me to resend my insurance card so that I can get re-approved for surgery. (May 17)
• I receive my approval letters, but they state my doctor and hospital are out of network. - (May 30)
• I call my surgeon's office to lament the fact that I thought they were in network and they aren't. They assure me they are in network and tell me I need to get a new letter before I proceed. - (June 1)
• I call the insurance company and speak to 5 different people/departments over the next few days and finally get the correct department who confirms my doctor and hospital are in network and will re-issue the letter. - (Jun 5)
• I receive only one of 3 letters that needed correcting. - (Jun 11)
• I call back and explain I need two more letters. -(Jun 12)
• I receive the final 2 corrected letters. - (Jun 18)
• I email everything to my surgeon, call their office and they say the doctor will call me to schedule. 
• I wait.
• I call the office to ask what the status is. Yes, they have all my paperwork, but they need a verbal ok from Dr. Hang my orthodontist. I immediately send Dr. Hang an email to ask him to call Dr. Henry  to discuss my case and let him know I'm ready. He responds right away to tell me he has a call scheduled w/him shortly to discuss other patients that morning and will most certainly give him my status.  - (Jun 22)
• Uggg. I wait more. 
• I called the surgeon's office again yesterday to find out why I hadn't yet been called. They said Dr. Hang and Dr. Henry spoke but that Dr. Hang said I wasn't ready yet. (What?!) I happened to have an appointment yesterday with Dr. Hang and one of the first things he asked was, 'have you scheduled your surgery?'! I told him what the surgeon's office said. He assured me I was ready and that he did tell Dr. Henry I was ready when they spoke. Uggg. So confused! - (Jun 27). 
• I just called Dr. Henry's office again now and relayed what Dr. Hang said. So, we'll see what happens next... This is head numbing. (pun intended)

p.s. so happy I have the email addresses of both my orthodontist and my surgeon. 

UPDATE!! 

Holy smokes. The surgeon's office just called to ask about a preferred date. Since I have a friend's wedding on Sep 30th and the first two weeks of Oct are crazy for me at work, I told them anytime the week of Oct 15th or 22nd. They will call me back after they check with the hospital's O.R. calendar. 

Insurance!

This wouldn't be a real surgery without a little "runaround" by an insurance company (only true in the U.S., of course). I had mentioned in my last post that my surgeon's office had re-submitted my case for pre-approval with my insurance company (Anthem Blue Cross). I received the approval letter on Monday... yay!!! I skimmed it and saw phrases like: "medically necessary" and "certified" and "You have chosen to receive services from a provider that is a non-participating network provider. Your services could result in significant out-of-pocket expenses."... say WHAT? I immediately called them, was on hold forever and the first agent I spoke to said "the doctor is contracted in New Hampshire, but your policy is California. Sorry." Without going on and on here about all the different people I spoke with and all the different things they told me, I will fast forward... The last person I spoke with assured me that my policy DOES cover out-of-state "in network" doctors. I finally got a hold of the department that issued the letter and they looked up my doctor while I was on the phone with them and agreed he is, in fact, "in network". (They had his first and last name mixed up, Henry Charles, rather than Charles Henry which is why he wasn't listed as a provider!) They've re-issued my letter and it't in the mail... So, to make a long story longer... I'm approved and my insurance will cover it!

So here's the breakdown with descriptions as they are written on my letter:

reconst lwr jaw w/fixation - Approved

reconstruct midface lefort - Approved

prepare face/oral prosthesis - Approved (splint)

excise inferior turbinate - Approve (deviated septum... i can't breath from my right nostril) 

1 day hospital stay - Approved 

2 additional days - NOTApproved

So, my insurance company will cover 70% of my surgery. I am responsible for 30%. HOWEVER, my maximum out of pocket amount is $5800, so that's the highest cost they can bill me for.