Monday, February 12, 2007

Insurance Company Won't Approve Surgery

Just when I thought this whole trip couldn't get any weirder, I am now in the middle of a battle with the insurance company over whether or not they will cover the I-GAP procedure.

The suits over at "HMO Central" are saying that since thy have doctors in network that do other free-flap procedures, they will not authorize surgery by the doctors I've chosen. Trouble is I'm not a candidate for any other free-flap, and if they knew anything about the procedures - or even read the medical reports my plastic surgeon sent - they'd know that.

I'm about half-way through the 15-day wait they impose before they'll make a decision on the first appeal level. Since surgery is set for March 8 - and they know it - I won't be surprised if they wait until the last possible minute to say yea or nea. If "no" is the word, I have to file another appeal and eventually appear before an ombudsman pannel to say in person everything I and both my plastic surgeon and primary care doctor have already said via letter.

Sigh. It's just amazing that after all that's happened to me over the last two years, the last leg of the journey is at a standstill because of an insurance customer service rep who can't - or won't - read a medical report.

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