Thursday, September 17, 2015

Surgery Update WTF

     Yeah so I would love to say I just haven't been posting everything because of my recovery, but that just isn't the case.  So when I last posted it was the start to the Labor Day weekend and I was told by the doctor's nurse that he would contact the insurance company Tuesday and she would call me with an update.  Tuesday came and by late afternoon I hadn't heard anything, so I called them.  After being put on hold for several minutes I was informed that the doctor would be calling tomorrow, the day before the surgery, because he wasn't in the office today.   I thought, "Really?!, but ok."

     The next morning I wake up and anxiously awaited the verdict.  I received the call around 10ish letting me know that the surgery has been canceled.  The nurse stated that the insurance company would not budge on their position that this surgery is exploratory and that with a procedure such as this requires medication, rest and alternative treatments before they will authorize the surgery.

     Of course it goes without saying, but I will anyway, that I was SUPER PISSED and extremely disappointed.  I proceeded to call my insurance company and vent my frustrations, which got me passed along from one person to another who could supposedly help me, I was finally transferred to a voicemail where I left all my info while thinking there is no way in hell anyone will call me back.  Little did I know that I would get a call back several hours later.  The conversation with the nurse for their medical staff, basically went back and forth just like a tennis match.  I could tell she was getting a pissed off with me because I wouldn't give in and kept on till after 20 plus minutes she finally said what the real reason they denied it.  Basically, Anthem has different procedures that no mater what have a list of things that must be tried before a surgical option will be explored.  Them denying my surgery wasn't because their doctor disagreed with my doctor its because of their policy and my surgery fit this bullshit policy.  So instead of doing what is medically necessary their policy has me jumping through hoops till they say otherwise.  

     After the conversation with the insurance company I called the nurse at my doctor's office to let them know what the ins company had to say, and that is when things start to get a little "funny" for me.  The nurse says that she is calling in a prescription to my pharmacy and will be mailing me a prescription for physical therapy that she will mail me.  I hang up and call it a day and instead of going back to work for the week, I decided to use the rest of the week to spend time with my wife, my family who were in town and for myself to just relax and decompress.  Friday my wife surprised me with a tattoo appointment because she wanted something to go right for me this week.  Only those that have tattoos and really enjoy the act of getting one just as much as the artwork involved know what I am talking about when I say that it was just the thing I needed to relieve some stress.  Wow did I feel so much better after we were all done. 

     So, fast forward a few days and this is where my head is at.

     I am beginning to think my doctor and his staff don't know what the fuck they are doing.  Sunday, a full four days after the nurse stated she was calling in my script, I stopped by the pharmacy and to my surprise there was no prescription waiting for me.  I thought to myself, maybe she meant she was mailing the script along with the PT prescription.  When Wednesday came and still nothing I decided to see just what the hell is going on.  I had to return the recovery medical supplies that I had received prior to my surgery that I wrote about here.  

     The medical supply company is located in the same office as the doctor and since I still haven't received my prescriptions for my meds and PT I thought I would kill two birds with one stone while I was there.  When I asked them about the medication and PT no one seemed to know what I was talking about.  The nurse I spoke with asked me to sit and wait till the doctor got out of a consultation so she could talk with him.  I was close enough to them that I was able to listen in on some of their conversation and when she asked him about the medication he said I don't care whatever we usually give.  After the doctor walked away, she called me back over to get everything taken care of.  After the nurse asked me what pharmacy I wanted the meds called into, she still ended up calling them into the wrong place.  I mean come on Dean, cut her a little slack, Right Aid and Walgreen's sounds exactly a like.  But I digress.  Oh, and the nurse on the phone from last week, the one that was taking care of all this, told me the insurance company needed me to have PT for 3 months and Wednesday the doctor only prescribed 6 weeks of physical therapy. WTF!  Doesn't anyone know what is going on?

     After today, I am on the fence about seeking a 2nd opinion and wondering if some of what the insurance company was blaming on the doctor was, in fact, true.


  1. Oh man. PT isn't going to help a labral tear. But if you gotta jump through the hoops then you gotta. That being said I have a hard time believing your insurance will cover 3 months of PT. Mine didn't even cover that much *after* I had the surgery. Seek a second opinion. Surely there's a way to avoid the insurance hoops.

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