Thursday, April 07, 2011

How Much Pain is "Medically Conservative"?

So. I picked up the mail when I arrived home last night and there was a letter from my insurance company denying my scheduled surgery for the biopsy and ablation. Apparently, the procedure is not "medically conservative" enough for their liking and therefore, they will be approve. I may, of course, proceed with the procedure at my own expense.

Ummm.....yeah. I'll just whip out the ol' checkbook and write a check.

Though seriously, if I could get the surgery at the same cost the insurance company would pay instead of, you know, twenty times more the cost, I might consider it. I could pay it off over time - a lot of time - but I could. (And can someone PLEASE explain to me why medical costs, if you have no insurance, is so damn high? Kaylen's ER bill arrived and it was just under $2000. They cut it down to $300(something) because she has insurance and then billed me $75 for the co-pay (which the secondary insurance picked up). So....a $2000 bill for no insurance was magically transformed to $300 total when there was insurance (of which they were only billed $225. WTF, people? W.T.F?!?!?!)

Today I will call the office to see what my options are. Can they resubmit for the retry at the biopsy in the OR since the office one failed epic-ly? Or do I have no choice but to go through that incredibly painful experience again? (Any guesses? You have been following my life for a while now. Which one do you think it will be? I already know.......*sigh* What's more pain, right? I already live in a constant state of level 4-6 pain, so why not add a bunch more (after all, it's only short term....3-5 days) without benefit of pain meds or anesthesia. Short term or not - adding more pain increases my overall pain load and's just no damn fun.)

I'm pissed. My doctor and I talked about the options. She and I decided the best course of action but my insurance company says "Oh we don't think so. probably IS the best course for you but we don't want to pay for it. It's not "medically conservative" enough for our liking so if you would, please try all these other ways which, in the end will cost us more than this one would and use a whole lot of your time and then...then if you are still dealing with it down the road, we'll talk. Chances are *fairly* good it's not's hoping!" *clink* *wink*

I tried the "medically conservative" approach. My body didn't cooperative. Not really my fault it failed since I have no control over my cervix (but let's leave me with the feeling it *is* my fault). Let's try it at least 4 more times, ok? Because it's oh so much fun to have equipment shoved inside of you. The searing pain that made me push back into table until I thought I would push through it and down to the floor? Not a good enough reason to grant me a different route.

Insurance is awesome. I'm so glad they know what is best for me. Next time I'm sick, I'll just call them and ask them what I should do...they seem to have all the answers.

So. Not. Fair.

Can I win the lottery now?


Tanya said...

You can only win the lottery if I can have some. :) And I feel the same way about insurance companies.

marie said...

Almost all hospitals will given self pay patients huge discounts. You have to ask they don't just offer, if your insurance still says no, call the business office of the hospital explain the deal and your lack of funds. Normally they will come up with a greatly reduced price. I'm an RN but worked in a doctors office pre-certing patients, and if they had no insurance helped them obtain the procedure at a greatly reduced price. Hope you get some where, health insurance is a joke!! I so know it from both sides, as I am now awaiting a kidney transplant. And trust me it sucks to be on either side of the insurance game!! Good luck!!