I give up

I officially no longer pretend to understand our insurance.  Currently, we have the basic option of our brand of health insurance.  We are not supposed to receive one thin dime towards the work of the plastic surgeon, according to the benefit* guidance.  However, as of this afternoon, we have been advised that with the exception of the cost of two appointments prior to the November 11 surgery we owe absolutely nothing.  There will be no itemized bill for $5,000 plus showing up in the mail soon and more importantly (yes, I nearly cried), I can have the implant-exchange that I really need.

I know that sounds selfish, but I crave this surgery.  I need some kind of normalcy back in my life.  I still avert my eyes, as looking is just too painful.  No matter what Peter or the plastic surgeon say, I see nothing remotely happy or beautiful on the right side of my chest.  It's scary and weird and feels creepy.  I'm sure I sound ungrateful, but after the past three months, I just don't care.  I am so ready for some sort of closure on some part of this whole nasty business.

Since more stress about this issue is not what I need right now, Peter is going to attempt to acquire written (notarized, if possible) documentation from the plastic surgeon that states how we

1. Owe nothing but the minimal costs for the first two pre-surgical appointments.  We have already been reimbursed by FSAFEDS for those, so not an issue.   
2. All costs from the surgery not borne by the insurance company are absorbed by Dr. X's office. 
3. All follow-up surgical appointments within 90 days after surgery are also included in the covered portion.  Therefore, all appointments since November 11 are covered and all follow-ups after next week are covered until late April.
4. We will also request that the DIEP surgery information be included in this letter so that there is no confusion next fall/winter.

Once we have this in writing, I will be far more reassured.  Not that I don't believe Dr. X's insurance guru, but I have had it with the knots in my stomach and the crying jags for fear that yet something else had gone insanely wrong.  I honestly don't know why the above can be true, given the type of insurance that we purchased.  If we had the standard option, I would believe it, however, in an interesting twist of fate, we would be out a lot more money.  Not only would the monthly premiums cost us an additional $2K per year, but we would be required to pay 35% of the charges for a non-participating provider.

I thought we were supposed to be fully responsible for all charges in our case.  Dr. X's office did achieve an out-of-network authorization, so we understand how the insurance is paying, but not necessarily the why. Is it the nature of the surgery?    In the end, I am not sure it is important, though I do wish that they had clarified the situation at the first office visit, not just stated, "You are covered…" without further ado.  We are just thrilled that our savings will remain intact and it is one less worry for us.  In fact, I may just enjoy car shopping this weekend. 

 

*This assumes we are reading it correctly.  The benefits handbook makes my head spin, so maybe we just don't get it, maybe there is fine print we have missed.  In that case, I guess we deserve the self-imposed misery.  However, at this point, whatever works (and can be obtained in writing) is fine with me.