Insurance ~ Again!

I received a letter in the mail today from our insurance carrier. It was addressed to me and it was not in the typical explanation of benefits envelope. My first thought was that it was another bill for something. Then I opened it. . .

The first few sentences were typical medical insurance mumbo jumbo, so I skipped to the important part where one word stood out like a sore thumb

D - E - C - L - I - N - E - D

It took me a moment to figure out what this was and before long I understood. This was for the Spinal Cord Stimulator. Apparently, they already sent it off to see if insurance would cover this device.In the letter, it stated that this therapy is considered experimental. . . much like the cryoablation that they denied a few months back!

The good thing is that this does not really matter since this was an option that we would not even consider!

Still Processing. . .

Well, yesterday came and went and I had the appointment that I had waited 6 weeks for. I arrived on time for my appointment and 2 1/2 hours later I saw the doctor. He was an older man with a heavy accent. He listened to my history and performed his exam and then he told us what he thinks. . .

• The illioinguinal nerve is definitely involved, but the genitofemoral nerve is possibly involved as well.
• Nerve pain can be self limiting (3-5 years) or it can continue indefinitely.
• We have options: (1.) Old School Theory: Perform a series of 10 (or more) nerve blocks to attempt to break the cycle. This would involve going in every 1-2 weeks for a block. (2.) Perform a diagnostic nerve block and if it gives temporary relief, perform a Radiofrequency Ablation on the nerve(s) which will provide relief up to 6 months. (3.) Insert a Spinal Cord Stimulator to inhibit the transmission of pain from the nerve to my brain, an internal TENS Unit of sorts. This has been proven to work but is VERY invasive and incredibly expensive. And then there is the insurance part!
  

We decided to go with the second option as it the easiest and can provide relief quicker than option one and is less invasive than the third. I left there with very mixed feelings. . . I know that things will happen in the way that they are meant, but I am scared. I am human. I hurt. I am tired. We have a date scheduled for the diagnostic nerve block. . . DECEMBER 8. 2011 - 4 months away. That feels like an eternity, esp when my hysterectomy was 5 months ago. . .

So, while I do not have any doubts in this doctor, I am concerned with (a.) his timeliness and (b.) that it takes SO long to get in for a 5 minute procedure. One thing that I LOVED was that he did not even try to give me a prescription for narcotics. The docs that I have see thus far have and that is not what I want. . . "Fix" one problem, yet create another. . .

While I am disappointed that he does not have a quick fix, I am confidant that we are doing what is best and hopefully following His will in the process. Like my Granny always said, "Lord, I'll make the motions, YOU do the work!"

"Let nothing perturb you, nothing frighten you. All things pass. God does not change. Patience achieves everything."
~Blessed Mother Teresa of Calcutta

The Phone Rang. . .

As I sit here sobbing, I wanted to let everyone know that, well, nothing can and will happen. There are no doctors that will perform this other surgery as it is "too risky" and with my luck, that will be more than true (and if it is that risky, I do not want it!), and the original surgery to freeze the nerve, although covered at 100% 2 months ago, is now considered experimental?!?!?! Seriously, how can something that has been proven to work and has been covered entirely prior, now be considered experimental? It works. We know it works. It is an easy fix --> Go to sleep. Make some cuts. Freeze the nerve like you would a wart. Wake up. Go home. No pain. It is my one hope of having minimal pain. I have done everything else. Had tests and procedures. Tried meds, all to no avail. Of course, I can pay for then entire 5 digit expense out of pocket, but we are not wealthy by any stretch of the imagination.

So, seriously, who knows more, some ass sitting at a desk who has never laid eyes on a patient writing new guidelines because he is scared of what will happen with private insurance or your doctor, the one who has treated you. The doctor that has laid his/her eyes on you. The doctor that has reviewed your medical charts and your test results. The doctor that has held your hand as you sobbed as you did not know how much longer you could put your family through the hell of dealing with a mother and wife in chronic pain. (For those of you reading this, I am not saying that I am in danger, just in the throes of despair and dealing with pain for over 2 years)

Waiting for the phone to ring. . .

When we left the doc's office yesterday, we were told that we would hear back from them by today at the latest. Around 3, I called them and left a message for someone to call me back with the status ~ either insurance denial/acceptance or did we find a doc for the other procedure. I heard nothing back. . .

I am trying to keep my mind from going straight to the negative, but I am having great trouble with that. My mind is just going crazy ~ Did the insurance flat out deny? Could they not find a doc to do the other surgery? Am I stuck with this pain forever? What is going to happen to me? My family? My marriage? How much more can we take? WHY?

So, here we are stuck for another day, left wondering what is going to happen. . . I know that there is a reason, but it is becoming difficult to pick my chin up. It is getting harder to put on that happy face. It is just difficult. . .

INSURANCE ~ UGH

This is merely a vent, so beware!

I go to the doc today to schedule the nerve surgery. My husband takes off work so he can hold my hand as we have the discussion of an 8th surgery in 26 months. We arrive and pay the co-pay, are called back and vitals taken, then wait. We go through the entire thing with the PA and she gives us all of the details of the upcoming surgery and then it happens. . . she looks up and sees our insurance carrier. She dismisses herself from the room while Robert and I sit there not knowing what is happening. When she returns, she informs us that our insurance does NOT cover this surgery. The one thing that we know WILL help, insurance does not cover. There is another riskier surgery, but the problem is finding a doc willing to perform it. . .

So, great, where do we go from here? We are going to go ahead and act like insurance will cover the original surgery. This means, I had had my pre-op appt today and we are going to submit it to insurance and just pray that it slips and gets approved. If they decline it, we will try and fight it. Also, while we are waiting, we are going to try and find a doc that will perform the other surgery. . .

I am devastated. We truly had put all of our faith and hope into this surgery and now that it might not happen is such a blow. I need relief from this pain. . .