Tuesday, November 27, 2007

Happy Thanksgiving

I hope everyone had a great Thanskgiving. Ours was really nice. The boys did great and we had a small gathering with my side of the family.

I was feeling pretty good all weekend until I got the letter from my insurance company saying that my abdominal surgery would not be covered. Evidently it doesn't matter to them that my muscle separation is the size of a entire hand rather than the normal 1 or 2 finger gap that you usually see in abdominoplasty patients. Nor does the fact that you can see my intestines moving just under the skin whenever I'm laying down. Because I don't have a "true hernia" (at least not yet), the surgery is considered cosmetic. Yeah, because having your intestines bulge out is just about looks...

Oh God.

I have three doctors willing to write letters to my insurance about the medical neccesity of having my muscles sewn back together, but somehow I don't think it will matter. So I now have to save up about 8 grand to pay for the procedure, which will be done in an outpatient surgical facility. This scares me to death. As much as I don't want to be back in the hospital, I'm really scared about having such a serious surgery done and going home the same day. But that's how cosmetic surgery is handled. If insurance would cover it, they could insist on a hospital stay.

I just feel so torn about what to do. Clearly I can't spend the rest of my life with my intestines putting on a show for me every evening after dinner. I need the surgery. But I'm so afraid of the complications. Some pretty bad stuff could happen to me as a result of the surgery, including death. Even though the odds of complications are low, I've managed to be one of the "lucky" few twice now (Only .08%of women experience HELLP and only a very low percentage of people require IVF with ICSI to conceive, while 16% of abdominoplasty patients experience complications.) Do I push my luck a third time? I've met two surgeons who seem cautious to operate on me, and one who is ready to do it tomorrow. (It seems to come down to experience--two of the docs just weren't qualified.) I'm going to seek a few more opinions yet seeing as I have to wait now to save the money anyway.

This sucks.

I feel like my life is finally moving on, but the stomach issue is holding me back and can't be ignored. I just wish there was a simple answer.


Bella said...

Get your docs to write those letters! It really may matter. Have them include all of your risk factors, too. If the insureance company perceives that they may be in trouble after the fact, they may be more willing to shell out now. We have submitted appeals (after having procedures done that were denied after the fact)and have had much success with that, so hopefully you can preempt it all and get approval now.

Linlee said...

Most insurance companies will deny you the first time automatically. Let the doctors write letters, $8000 is alot to pay out of pocket. Might as well give it a shot. All they can do is deny it again. I had to fight to get 8 weeks of maternity leave, they only wanted to give me 6 for a c-section!

GLouise said...

Yes, please do have at least two doctors write the "strongly worded" letters. I do think it will help. Keep writing even if it takes several times. I hate insurance co's!

Best of luck to you!!