Tuesday, January 12, 2010

Surgery

Israel was supposed to have surgery on December 9th, but they had to reschedule due to a conflict with the surgeon schedule. So we were on for December 30th. We had been planning for this day for months now. We had schedules rearranged, the older kids were going to my sisters house for the week, Jon's work schedule was changed to meet the needs of this surgery and many, many other preparations had been made for this day. Especially the preparation of our hearts and minds. The day before his surgery we got a phone call from the hospital asking questions about insurance. This story might get long...so bear with me. Since we own our own business we have private insurance. Along with that, Israel also has Medicaid/Disability insurance which is provided by the state. In November it was brought to our attention that we could switch health care plans and take Israel off our private insurance and save ourselves a lot of money each month. Medicaid would step up into primary insurance for him and still provide him full coverage at no cost to us. Obviously we took it! Well, the hospital didn't get this memo, because they didn't check until the day before Israel's surgery, which was 29 days after our other insurance became inactive. Plenty of time for them to get details ironed out! They had to get pre-authorization for Izzy's surgery, but due to lack of knowledge/communications somewhere between the hospital and the insurance company they were trying to rush and make it happen so he could still have his surgery the following day. We got the case looked at...and they denied him. Stating that the surgery wasn't medically necessary! WHAT?! How could it not be? If Israel doesn't get this surgery done he won't be able to eat solid foods or talk! The surgeon was outraged and insists that Israel has the surgery. The hospital has submitted an appeal to the insurance company (Meaning the doctor wrote a personal letter explaining why Israel needs this, they also sent pictures, chart notes etc.) We are now playing the waiting game while the insurance takes another look and decides if they will change their mind. We probably won't know anything until at least the end of the month...if not longer. This has obviously been a very frustrating and trying time for Jon and I. We have tried desperately to understand the heart of God why we not only have to go through everything on a daily basis with Israel...but then have to deal with more junk like this too. But alas, we have just had to rest in the fact that even though we may have NO idea what God is doing and why, that he is always in control, he does not make mistakes and he knows exactly what he is doing with Israel and with us. Please be in prayer for all of the insurance stuff to work out, and in a timely manner as well. We will keep you posted as more details surface.

To read more about the details of this surgery, Click Here

4 comments:

Svetlana said...

OOO yes, we been battling this for awhile with state insurance. it is better to have second insurance, that way if Medicaid doesn't cover something, then your own insurance can or other way around. Also u can call insurance and find out if they need anything from you too. We learn that sometimes we have to push their buttons to get what Anna need. Next time before any surgeries or even other appointment try to call to make sure everything is set for him. We will be praying for his coverage.

The Cameron Family said...

Praying for your family Becca

tamisue said...

I totally feel ya! We have actually thought about moving out of state just to get better support and help for Joey. We didn't even realize how bad it was in Oregon until we moved to Kansas City. Anyway, we will be praying and if you need anyone to talk to or any help, you can call. Love ya, and good luck.

Anonymous said...

Keep up the battle Becca. I know from my own past experiences with my own son and his medical needs - the squeaky wheel get's the oil. Keeep on them and ask over and over...it will happen. I will pray for you all - love ya - Jenee