Monday, April 20, 2009

Another Update.....

Ok...ok...ok.... I am posting!

Friday evening I got the mail and found the EOBs for our surgeries. Tom's was covered 100% and mine was NOT covered. It was too late to talk to anyone about this and I have been a fuss-fidget all weekend. I left messages for our Case Mgr at the insurance co and our surgeon's office.

Got a call from our Case Mgr first thing this morning.....she was all "I will help, I can take care of this...." UNTIL I mentioned that my Roux-En-Y had been converted to a Sleeve at the last minute.... I practically heard her brakes slam down over the phone. She says "Oh no....that is experimental and not covered...not sure what I can do.... Call your surgeon....bye" (Not quite so harshly, but that was what I heard).

I called the surgeon's office and explained what was going on....And this is where I heard "This claim will probably be denied several times, but DO NOT WORRY, we will get this covered and paid for. We do this ALL THE TIME....and it might take awhile, but it will be taken care of... Don't you worry, just get well!" Ahhhhhhhh...... Have I mentioned how much I LOVE my surgeon and his staff???

Today we had a new home nurse to do Tom's VAC change. She was very nice and very thorough, but she wasn't our NORMAL nurse. So she didn't really have a basis for comparison. Tom has a small area (think clock.... area between 5 and 7) that is reddened and firmer and a tad warmish. Something to watch, as it could be the natural healing process, could be beginning of infection (although temp is perfect), or possible celuitis. The best would be the natural healing process....the worse might involve debriding as an outpatient or inpatient for a few days. I will watch his "ouchie" like a hawk and pray it is natural. It was not like this during last change on Friday.

I seem to be in a holding pattern with my weight. I put on a pound last week (how in the hell does that happen when I am eating less in a week that I used to eat in one day???) I am going to start with the stationary bike and treadmill this week. Maybe I need more exercise than just walking...who knows?

For those who have mentioned shopping-therapy.....I have. I already have enough pants to get me through for a few months. But my tops look silly, I have bought a few to get by. Next is a bra. Mine is a riot. If I lift my arms, I might strangle is that loose. I am using a sports bra now, but that is almost too big.

Swan is trying some of the recipes on the EggFace blog. Last night we had a small crab item (made in mini-muffin pans) that was like a cross between crab rangoon and egg foo young. Tasty. Tom ate 3 and I ate 1 1/2. I found a recipe for BAKED Falafal and am going to make it for tonight. With a cucumber/yogurt sauce and hummus on the side....sounds tasty to me.

That is it for me. I am off to the shower.



M:e said...

Oh never fail to make me smile. You always sound like you look in the pictures recently posted here, a mixture of fun and don't mess with me!!

I do hope they get all this insurance stuff sorted out if you didn't have enough to worry about without all that nonsense. If they don't, it sounds like you have the perfect tool to strangle them with!!

love and hugs xxx

Anonymous said...

The last thing you all need to worry about is medical bills and insurance worries. I hope that things get settled without causing you more grief.

Think positive....

Anonymous said...

Was glad to hear from the both of you..will keep everything crossed that Tom,s wound is healing...when you are all feeling better wondering why they changed your procedure at the last minute?

Keep well,


Impish1 said...

So the trials least you can amuse all with a comedy show in those silly clothes if you don't finish the shopping! Thinking of you, don't give in to the stressors.