09 July 2015

Surgery Cancelled.

Can I just say how sad I am?  Sad... Disappointed... Angry.

All the work and effort that went in to today...for it to be cancelled because of 27 words:

"Exceptions include: Sinus or other nasal surgery, including correction of a deviated septum by submucous resection and/or other surgical correction, except for a covered injury."

Apparently, our health insurance, which is a student health plan from Baylor University, excludes any sinus surgery for almost any reason, even if medically necessary...including the life-threatening disease, Cystic Fibrosis.

But, as that in itself isn't bad news enough, nobody bothered to tell us this until we were admitted to the hospital.

Bennett, in his thin hospital gown, waited patiently to get his sleepy medication.  He had been waiting all day to eat and drink.  He was ready to get this show on the road.

Doctors and nurses came in and out of the day surgery room asking questions, preparing for surgery. But I stayed on the phone.  We had to get this resolved.

How could this be?  Medically necessary sinus surgery is just excluded?!

Apparently so.

The OR stood ready.  Versed was ordered.  But then cancelled.  The doctor, dressed in her scrubs, came in on her cellphone.  We could hear the elevator music in the background as she waited for Blue Cross Blue Shield of Texas to pick up.  She had hoped to tell them that the evidence was clear: Bennett needs this surgery.

But a bit later, I saw her through the window of our room shaking her head as she opened the door. It was over.  "I'm sorry.  I tried."  There was no recourse.  We were going home.  Insurance is not going to pay.  Sinus surgery is simply excluded.

Realizing we would be stuck with a $24,000 bill if we went forward (and maybe more if something went wrong during surgery), we decided we had no other choice but to leave.  We will have to figure this out before we would be able to come back.

I can't even explain how much my heart hurt to have to pick up our stuff and leave. We've been watching our little guy suffer with headaches for a while now.  We've seen the CT scan of his sinuses filled with thick yucky mucus.  We were all so happy he was going to get relief.  But that wasn't an option any longer.

It's hard to believe that during a time when the Affordable Care Act is mandating so much, somehow student health plans are able to get away with excluding whole organ systems from being covered by insurance.  And what's sad is that families like mine are not even aware of the impact of these exclusions until they they need them...or, in our particular situation, show up for them.

This is life with a chronic disease.  It's often not the big things that are so painful, but the little things experienced along the way.

I will never allow this to happen again.  I will pay closer attention to the exclusions in our health insurance policies.  And I won't bother leaving the house until I have confirmed insurance coverage.  But these sorts of things are often learned trial by fire.  It's hard to know what you don't know, until you realize you don't know it.

Our insurance plan will change shortly and we will then reevaluate our options.  We hope Bennett will get the surgery in the near future.

But for now, we will just go home and continue on as normal.

...after mama has a good hard cry.

This isn't the way it's supposed to be.

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