I should be in the hospital right now

Miscellaneous and Personal Stuff I Must Share
1

Some of you may have read about my long saga with a spine that’s like a splintered tree branch half hanging on compounded with a crushed vertebra that remains extremely painful despite a kyphoplasty that didn’t work.

So, onward to a third corrective surgery with a third titanium cage, complicated by the cement ball left in my spine from the kyphoplasty and by the fact that the hospital no longer contracts with the maker of the old cages, meaning that the nuts and bolts that hold them together are not compatible with the new versions and everything needs to be replaced. I wish I were kidding.

I finally, after weeks of asking, got a firm date for the surgery. Yesterday, as is the custom around here, I called the hospital in the afternoon to learn my arrival time. 10am Wednesday, August 26. Fine. I’m ready, I’ve been planning for days.

A few minutes later: an unexpected call from the surgeon’s office. Hi. Sorry to tell you no surgery tomorrow. Was the doctor hit by a car or something? Worse. My insurance company, Excellus, hadn’t given approval. What, they turned it down? Well, no. They didn’t approve and they didn’t not approve. They just never bothered to respond no matter how many times the office called them. There was a legal flat deadline of 3pm yesterday. I got the call at 3:39.

I’m in limbo. I’m the perfect candidate for such a surgery: history of decaying spine, long series of milder procedures tried and unsuccessful, pain management impossible despite major current pain, movement severely limited. The first time I saw the surgeon he told me I needed this even if the kyphoplasty went well. I tick off every box. The office has no idea why I would be denied but also no idea of why Excellus is ghosting them.

Having lost my place today also means that the next available slot is a month away - if they get a quick approval. If they need to fight with the bureaucracy, who knows when that will be resolved.

I don’t know how to end this. Too many emotions fighting inside my head to express any one. Honest, officer, I had the walk sign and didn’t see the bus coming. What bus, you ask? The invisible bus that wasn’t there.

2

i’m so sorry.

ghosting seems to be the standard for insurance these days. they hope you will go quietly into the night.

rage on!

3

Can you consult a lawyer? Your contract with the insurance company may have requirements about timely decisions, or something like that. If they’ve violated something, it might be worth investigating.

Good luck!

4

Terrible. I’m so sorry.

5

I’m holding off actions of my own at least through the end of the week to allow the surgeon’s office to lead the battle through the bureaucracy. Never try to reason with somebody when you just want to scream.

6

Man, that’s f’n terrible. Emotional pain on top of inescapable physical pain. I hope it gets cleared up in some way for you :frowning:

7

Shit! Call the insurance and give them hell! Call customer service, call their appeals dept - make them call you back!

For my surgery earlier this year I was offered to move the procedure up by 5 weeks, which gave only about a week to see that all the approvals were in order - I was not worried about it at first because there was plenty of time for everything to work thru the system.

But now, it was only days away from the scheduled surgery! I called the insurance company daily and was able to be sure the insurance, physicians group doing the referral, and the hospital/surgeon were all on the same page and the authorization was progressing thru all the hoops. The authorization was escalated and was approved in about 4 days. All of this took effort on my part - this stuff does not just happen - I had to advocate to get it all escalated (of course, the hospital where my procedure was happening told me if the authorization was not approved and received by them by the time of my surgery, I was on the hook for the whole bill (!!) and would have to sort it all out with my insurance afterward), so I was motivated.

My only advice is to call the insurance and ride them hard until the surgeon/hospital where you are having the procedure confirms everything is approved and authorized, and they can give you a cost estimate for your portion of the bill. I hate this shit but unfortunately you have to do some of the leg work to be sure things are in order. Sorry!!

8

You’re probably right. I need to get my head together.

9

Definitely the vast majority of rage is reserved for your insurance company, but this nonsense drives me crazy. How about involving me in the process? I have a vested interest in getting it solved.

I recently had a colonoscopy cancelled, after I’d already started prep, because the GI’s office hadn’t gotten electrophysiology clearance by their artificial deadline. Of course, they didn’t tell me they were having a problem until after that deadline. I obtained clearance within about 30 min of calling the right phone number for my EP (I have no idea where they’d made up the four different bogus numbers they were calling).

10

I’m so sorry. What a nightmare

11

There might be a state agency in charge of insurance companies that you can get involved if necessary.

I think some people have even gotten help from their state’s senator’s offices.

I agree that if your doctors are actively fighting this giving them a short time to do so — and for you to be able to talk without swearing — might be a good idea.

12

My spouse had an opposite experience. Months of run around and outright lying from our insurance company about securing pre-approval for spine surgery, while she was in extreme pain restricted to lying lying in bed for probably 23.5 of the 24 hours of the day. Denied. Appeal denied. Surgeon consulted with the insurance company, and we “got” approved but they couldn’t provide documentation to the hospital.

When we finally got the approval it was for the next day.

Sorry you’re going through this, the insurance company prefers that you suffer or die.

13

Disgusting. Insurance runs the country and is the biggest scam on earth.

Sending e-hugs and good vibes your way.

14

Thanks to everyone who posted here. I needed to vent to somebody - beyond my wonderful, long-suffering wife - who would listen. It will all work out somehow. And the same hope for all your travails.

15

I am so very sorry you have to deal with this on top of what you’re already experiencing.

16

I feel such concern for your plight.

It’s hard to be ill and in pain in a world that treats you like a number on a form and not really human.

Crossed fingers and good wishes. I do hope it’s worked out sooner rather than later.

17

This sounds like something United Health(denialof)care would do.

18

The madness continues.

I received two forms in the same mail. One was from the insurance company telling me that had denied the operation apparently because they didn’t receive a recent MRI or CT scan. I’ve had both. The form was dated Tuesday, the day the operation got cancelled. Does that mean I’m cutting them some slack?

No. The second came from a different company, giving me instructions on how to appeal the denial. This form was dated last Friday. If they knew back then, why didn’t that information make it everywhere?

I called my surgeon’s office and the person I talked to said they were already on it and working to reverse the denial but didn’t know where the breakdown occurred.

Somebody screwed up royally. Maybe everybody did. Can’t wait to see what happens next.