Everything will now come your way

I’m sick. Yes, I know you already knew that but its cold and flu season and I am even less immune to these nasty bugs than the general populous. I’m coughing, congested and sounding pathetic all of which will hopefully impress the decision panel at the health insurance company. As many of you know, it was Decision Day (aka The Showdown) with the medical review panel at my oh-so-helpful insurance company today. And to be honest, I have no idea how it went.

It’s taken over four months to get to this point. According to the company’s handy dandy website, this so called “expedited” appeals process should have taken less than a month. Ha! I have project managed the heck out of this appeals process and my physicians are rather amazed I’ve been able to get it to go this quickly.

I didn’t sleep well last night. I went and did a longer session with my physician therapist this morning just so I could try focusing on something else. My endochronolgist called this morning to verify that she had the right phone number to call into and we quickly reviewed strategy. At high noon, Husband was by my side when the call was made (and dealing with a dying water heater - but that’s a story for tomorrow).

It started out like any other professional business call I’ve been on. You receive a conference call in number and a passcode to access the planned called. Once you’ve dialed in, the conference calling system asks you to identify yourself to the group and then you sit and wait until the calls “host” activates the call. When I called in at precisely noon pacific standard time, there were already four people waiting on the call. My butterflies went into high gear.

Several weeks ago, I had to get very pushy with the organizer of this meeting to ensure that my physician would be allowed to speak on my behalf. They claimed it would be difficult to reach her, they had to get something scheduled right away and that they wouldn’t have time to wait for her to call them back. If I wanted her to participate, I would have to figure out how to get her there. As all good project managers know, when the going gets tough, treat the tough like kindergartners.

I walked the organizer through all the different phone numbers she could use to get a hold of Dr. Olive, I laid out how to walk through her phone system. I told her exactly who to ask for, what to say and how best to get an immediate response. Most importantly, I reminded the organizer that she\they would be in violation of state mandated guidelines that were posted on THEIR website, if she didn’t get the meeting scheduled that afternoon. Amazingly, she got it all put together.

But back to the phone call… The organizer asked everyone to introduce themselves. There was one doctor, two nurses, the organizer, Dr. Olive and myself. The organizer then turned the call over to Dr. Olive by saying “Well, go ahead…”

The intent behind this call it to get my surgery paid for. Of course, that requires Dr. Olive to make me sound as sick as I really am.  She walked through the list of every issues, its impacts and its ongoing effect on my health. It is amazingly painful to hear. Diabetics, both Type 1 and Type 2 are told, almost from the beginning of their treatment that if they’d just take care of themselves, they’d be fine. Listening to all that is wrong with me sounds like a long litany of failures on my part. Dr. Olive doesn’t treat me that way but it hits pretty hard none the less.

Once Dr. Olive was done speaking, the organizer asked the panel if there were any questions. The doctor on the call asked if I had anything to say. This was the part I was dreading. I have so much to say, I am so exceptionally angry and I didn’t want to be unprofessional and start sobbing like an idiot. I walked through the length of my condition, they quality of care I had received until I met Dr. Olive over a decade ago and shared the lengths I had gone to in order to find the team of medical professionals I work with now. I reiterated my commitment to my own health and stated categorically that I would answer any possible question they had.

At first, it seemed like no one was going to ask anything. Finally the organizer asked each panel member individually if there were any questions. One nurse did ask me if my lap band surgery had previously been approved by this insurance company. I walked them all through my past situation – the incredible health insurance with Husbands other company, the recruiting process his new firm went through to get him to work for them, and all the ensuing difficulties I’d faced once Husband started with the new company. I also stated that if this appeal was not voted in my favor that we would be involving Husband’s HR department, we would be pushing for a final and extraordinary appeal (their words, not mine) and have an attorney familiar with the case ready to work with us if necessary. I also stated that my husband in considering new employment opportunities, at a significant cost to his career, in order to find better health coverage for our family. Unfortunately, these are all true statements.  Dr. Olive took an additional moment to add up the additional costs the health insurance company had spent to date and that if the surgery was not performed, the potential costs to them for my care going forward.

No one had anything else to say. When I asked the organizer when I would hear about the decision (I’ve been quoted everything from 180 days to 30 days to a week), the organizer stated that they would send out their decision to me by registered mail on Wednesday.  

The organizer announced that they would then terminate the call and they would  discuss the information. I hung up my phone and promptly fell apart.

Husband swears to me that I sounded professional, well organized, educated and thoroughly business-like. I’m glad because I was really afraid that I would come off sounding as angry and desperate as I feel.

I know health insurance is a business. Like all business, it needs to make a profit and there are lines and treatment policies that must be implemented and followed in order for it to be a profitable and investment-worthy business. I just wish that my life wasn’t the commodity on exchange.