Temporary insanity

Moving sucks.
I am officially no longer a Dallasite. Since my lease is ending this week and my surgery is coming up so soon (less than three weeks away--16 days to be exact), I decided to move in with my parents in Kennedale. My dad and sister (Misty) work from home, so they'll both be able to take care of me. Mom works, but she'll be around me quite a bit, I know!

My other sister, Wendy, will also be living at home for a few months while she opens a new business in the area, so we'll have a full house.

While I love my parents and their home, I hope to be back in Dallas, living on my own, by May. We'll see how everything goes.

So Saturday and Sunday, my family helped me move. Today, I'll clean out my apartment and turn in my keys. *tear* Moving was awful. I hate it. When I move next time, I won't be able to help that much. My family (sorry again!) will probably have to do most of the work as I will still be recovering.

You've got to be kidding me!
Last night, I was in my bedroom at my new residence unpacking some things when I came across my mail from this week. In it was a letter from my insurance provider, Aetna, dated Dec. 18, 2008 (less than one month before I have to go in for surgery).

The letter said that they were denying coverage for all parts of my surgery.

Let's let this sink in a little.

Denied. All parts. I'd have to pay for everything. Impossible to do.

Here's the rundown of all the surgery procedures they denied (a lot of these were given to me as abbreviations, some of which I knew and others I did not):

• Arthrodesis Post, for spinal deform, with or without cast; 7 to 12 vertebral segments 1 time--COVERAGE DENIED
• Posterior Segmental Instrumentation; 7 to 12 vertebral segments 1 time--COVERAGE DENIED
• Allograft for spine surgery only; Morselized 1 time--COVERAGE DENIED
• Autograft for spine surgery only (including harvesting the graft); Morselized (sep incision) 1 time--COVERAGE DENIED
• Bone Marrow Aspirat only 1 time--COVERAGE DENIED
• LA, FA & FO (UN/BI W/DE SP C, CA EQ A/O N RT(S) (EG SP/LA R ST) SI VE SE TH(SSO) 1 time--COVERAGE DENIED
• LA, FA & FO (UN/BI W/DE SP C, CA EQ A/O N RT(S) (EG SP/LA R ST) SI VE SE LU (SSO) 1 time--COVERAGE DENIED
• Osteotomy of spine, posterior or posterlateral approach, one vertebral segment; Thoracic 1 time--COVERAGE DENIED
• Osteotomy of spine, posterior or posterolateral approach, one vertebral segment; Lumbar 1 time--COVERAGE DENIED
• Arthrodesis, posterior or posterolateral tech, sing level; Thoracic 1 time--COVERAGE DENIED
• Arthrodesis, posterior or posterolateral tech, sing level; Lumbar 1 time--COVERAGE DENIED
• Arthrodesis, posterior or posterolateral tech, sing level; each additional vertebral segment 1 time--COVERAGE DENIED
• One day surgical--COVERAGE DENIED

Shit. I freaked out. I told my parents. Dad seemed calm and said we would call the doctor and Aetna first thing in the morning since it was currently after 5 p.m. on a Sunday. Mom freaked out more than me.

Apparently, in all the denials, it said that there wasn't enough medical evidence to show that this was medically necessary. It said my doctor failed to provide a required CT scan or MRI. Well, I haven't had either of those yet. Those are done close to the surgery date, so they give the most current view possible.

In the letter, it also discussed how to appeal. It said they have 30 days to make a ruling on my first appeal. I don't have 30 days!! My surgery is in 16 days!!

Sigh of relief
First thing this morning, I called my doctor's office and left a message for my patient coordinator. Amber explained to me the situation.

They received the same letter from Aetna last week. She immediately got on the phone with them and argued about why this is medically necessary. Eventually, they setup a "peer to peer" consultation between my surgeon and an Aetna doctor. Dr. Hostin explained all the reasons why I need this and gave them proof.

Aetna conceded. Hallelujah! They said they'll cover me for the surgery and everything that goes along with it.

One thing though, since my insurance plan is changing on Jan. 1 (it's still with Aetna, but just a better plan), we would have to re-apply for approvals on Dec. 31. Amber said not to worry. She said they assured her that it would be approved again. I should have a definite 110 percent answer by next Monday.

Breathe. Breathe. Breathe.

One more thing
I also received a letter from Dr. Nguyen's office. He's the on-staff physician at the hospital who gives me clearance for surgery at the hospital. He also will check on me each day while I'm at the hospital.

The letter asked for all my medical records from the last two years from an array of different types of doctors. This letter was dated Dec. 18, 2008, so I basically just received it, too.

Thankfully, of the types of doctors they asked for, I had only been to one clinic in the time period requested. I gave my wonderful father authorization to pick up my records, and he is doing so today for me. This was a relatively easy thing to do, but it would have been awful and near impossible had I seen more of these doctors. You would think you'd get a little more time on these things!

In summary, there were many headaches this weekend and even some tears. For the most part, everything has been resolved and is on-track. This surgery stuff is a very complicated business! Thank goodness for my wonderful family, friends and patient coordinator for getting me through this. xoxo to you all!