Insurance Woes

Called insurance company today with a list of doctors who do LAPEX. Some of them are more world-renowned (says Google) than others. Among two of the less-renowned are Dr. Robbins in Maine and Dr. Dulemba in Texas. What's noteworthy about Dr. R and Dr. D is that they are, out of the 9 practicing physicians still on the list (yes, folks, that's only 9 in North America who do this surgery, and 2 of them are in Canada), they are the only ones contracted with our insurance company.

Big fat sigh. So i can drive 10.5 hours to Texas for surgery and stay in a hotel until i'm feeling well enough to drive the 10.5 hours home, or i can continue to hope and pray that my OB/GYN is willing to call my insurance and convince them to offer out-of-network coverage. i tried explaining that my other alternative is a laparotomy, which i don't particularly want and i don't really believe that they particularly want as i would have to stay in the hospital for a week and the risks of other complications is much higher. Or i can pay out-of-pocket. (Yes, i might really be crying a little on the inside right now).

i was under the impression that the CEC had people on staff to work with insurance companies on authorization issues. But when they called last night, the lady said, "i was calling to schedule your surgery but it says here you don't have any out of network benefits, so i can't do that." i responded that as i understand it, the insurance does make exceptions in some situations and it needs to be pre-authorized and such. She said, "Well, when you get that worked out, give me a call and i can schedule surgery for you." Super. i don't think i've felt so on-my-own since i separated from my ex.

My OB/GYN's nurse returned my call yesterday, and i explained what was going on and that i needed to ask the doctor if she would write a letter (as it turns out a phone call is required) to the insurance company and explain about my options and why they should extend coverage to the CEC for this surgery. She said she'd talk to the doctor, and i'm waiting for someone to call me back there.

Well, whatdyaknow? (Not much, you?)