Impasse

It has been three weeks since my doctor gave me a referral to my local surgeon.  I am no closer to having surgery than when my doctor sent the referral.

My local surgeon says his office and hospital cannot perform the surgery because they are not approved by Medicare for weight loss surgery.

My Medicare supplement plan says the surgeon and hospital are approved by my plan.

The surgeon’s office says they are not a Center of Excellence and that only COE’s can do weight loss surgery on Medicare patients.

The insurance company says they follow Medicare rules AND the surgeon and hospital are approved according to their approval team.

The surgeon’s office said they would start the approval process but the patient advocate said, “I already know this is going to fail…but I’ll get the authorization going if you want me to but I have to tell you this is going to fall apart.”

Sigh.

My other option is to go to a surgeon over two hours away who is willing to perform surgery on me without conducting a pre-op physical exam.  His practice is a Center of Excellence.

Excellent…..?

His practice happens to be out-of-network so my costs will double not including the travel and hotel expenses for my husband.

I have had six abdominal surgeries and have a history of blood clots.  How is it in my best interest to be cut open by a doctor who does not know me and then remain immobile while traveling immediate following surgery just to get home?

I heard the patient advocate say she would start the approval process but I also heard the doubt in her voice so I am not surprised it has been a week and I have not heard from her.  No part of me believes she is working on this because she is already convinced it is not going to happen.

While I know the details will be worked out, I am at an impasse.

However, in writing this out–this is why I love being a writer–I realized there may be a middle-ground solution.  I could ask the patient advocate at the COE to schedule me for a pre-op appointment and see what she says.

This whole process is nuts!

Answers sign

 

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