Monday, November 23, 2009

What a Start...

Today was not a good day. After going back and forth with D., and the insurance company, about 12:15 pm this afternoon, I was told it was D.E.N.I.E.D. I went as high up as I could just to see if anyone could help me further. I was told the reason it was denied was because as a school board employee, I do not have out of network coverage. Contrary to what my employee packet says, and despite having the "High Option HMO Plan", I do not have an out of network benefit. Needless to say I was devastated (and thats an understatement).

Seeing that the procedure is a little over 3 weeks away, there is no time to appeal it, and as I was told, even if I did, it still would not be covered. I was told that my Dr. has to fight it, but really it is useless, and D., as we all know is incompetent, so I would not put much faith in her.
Right now all I can think is WHAT THE HECK AM I PAYING THEM FOR?

There might be a silver lining because I found a Dr. in Loxahatchee (about an hour or more away) who does perform the procedure. I took the day off tomorrow and Dh and I will be making the long drive in the morning.
I also found 6 other ladies who had him do the procedure, and the outcome was good. The only downside is that he does the LAP TAC, and based on my research, it is not that foolproof - I am going to see what he would think about doing the traditional TAC.
I am not so confident with not having Dr. D. perform the surgery, but I promised dh, I would at least hear him out. If I feel in any way uncomfortable, I am going to trust my gut and not have him do it. If that is the case, I will save, scrimp, and eat tuna everyday in order to have Dr. D. perform the procedure.
I am willing to hear him out.

Some of his credentials are:
* He invented the Laproscopic Cervico Isthmic Cerclage
* Board Certified Gynecologist
*Professor of Obstetrics and Gynecology at Tuft University
*Published Author and has written 38 studies published in the Journal of Medicine - the latest in may 2009 and based on the TAC
*Runs 2 offices (Loxahatchee and in New Mexico)
as well as a bunch of other accomplishments

His credentials sound good on paper, and the 6 people I discovered has good outcomes. One lady who I personally contacted had twins and at the time she did hers in 2007, he had performed 32 in total.
He has been placing the TAC since 1990, when one of his employees/nurses had an Incompetent Cervix - she went on to have her child/children with no problems. His success rate as of 2007, was 100% (not sure of the latest). He has been doing the LAP TAC since 2007.
He is in network and I am waiting on a response from D. I asked her to please ensure that if I find a Dr. in network, that it will be approved. Now that I think about it, I better call myself tomorrow morning.

My sister is telling me to get a loan, but I refuse to take out a loan and pay interest for the next 15-30 years on a procedure that should be covered because it is medically necessary.

So, we will see what tomorrow brings. I am really disheartened and upset with the school board. I am going the hear this Dr. out, and then make a decision from there.

Where is my expected end?


  1. I'm so sorry that it was denied! I agree with you about the procedure being medically necessary and you shouldn't have to take a loan for it. I'll be praying for you tomorrow and hope you get the answer your heart needs to hear.

  2. I'm sorry you are having to deal with that, insurance companies are just a**holes sometimes. I hope this doctor you are seeing tomorrow inspires trust so that you are able to have him perform the procedure and it be covered.

  3. Marie, I sure hope this works out. I am sorry you were denied. I will be praying for you.


  4. Praying your meeting with the in network doctor goes well tomorrow. Please let us know what happens, okay.

  5. Marie, none of that makes sense. I could understand a denial because there are other docs in the network who could perform the procedure, but because you don't have coverage? That verbiage does not make sense because they can approve as in network.

    Know that I am thinking of you and praying for you. *huge hugs*

  6. I just can't believe how awful your insurance coverage is. I mean...I know there are procedures and regulations, but come on, doesn't anyone have a heart anymore?? There comes a point when someone's conscience should kick in. I'm so sorry, Marie.

    I'm glad that there is another doctor that seems to have great credentials and results. Definitely hear him out. You never know, he might have been part of God's plan all along, and all the other stuff was just to make you stronger!

    I love you, friend, even though I don't really 'know' you, and I'm praying for you so much. I don't understand why God would allow this much crap to be happening to you, but it all just shows me and others what an incredible woman you are!!

    Good luck with the doctor today!

  7. Okay, pardon my french, but DAMN. This is not right!!! This is a medically necessary treatment! Where do they get off???

    Have you looked to see if Dr Haney in Chicago is covered? He is a miracle worker. I would hate for you to feel like you "settled" for a LAP TAC if you could have what is considered a more foolproof TAC.

    I am praying, Marie, that God shows the light at the end of this tunnel. I cannot belief they DENIED your claim!!!