For those of you following my insurance and Dr journey (highlighted also in a poem post lol), I have a great update.
I learned that sadly, after getting the out of state gap exception / single case agreement), my insurance still denied the surgery payment.
I had left my dr’s practice manager a message that it was denied and that I was doing my best to take care of it. I hadn’t wanted her to freak out when she got wind of it.
Anyway when she called she said she checked dr Annino’s post-op note and was so glad to see that I responded so well to surgery. She said she saw the symptom relief I got. Said “wow”.
I corroborated that and told her how well things went at the hospital. I said I was glad that the hardest part was getting the authorization ahead of time, thanked her and wished I could thank Virginia (scheduler) too. I said that hearing her say how bad my insurance was and that I shouldn’t have gotten through the door, and that they wouldn’t let anyone through again, was the hardest. (I felt I HAD to reiterate that, I was still bitter).
She said that she’s now created a streamlined way to handle Eagle patients billing as she’s learning they’ll be from all over. And she said “It’s not like you’re coming in with an ear ache, which would justify me to tell you to go elsewhere, just because we aren’t contracted with your plan”. She also said she sees there are very few doctors who really have the expertise he has with this.
Ummm this is everything I had already told her. But I kept quiet, she was saying it like she was discovering something new.
She then said “I think these things will likely always get denied at first go, and that it just needs to be followed up on.”
I am so happy I could cry. Now they’re going to allow others with out-of-state (non-contracted) insurance to get this surgery. And now I don’t have to be concerned that he will turn around and say he won’t do my second side if I need it.
Now, onto my appeal to get this paid out…