Wednesday, November 23, 2011

The Plot Thickens

Met with Dr. Lenke this morning who is shocked that our insurance is not cooperating.  In fact, he said he has never experienced this before.  It seems the explanation of denial was lost in several translations, but now boils down to this.  Dr. Lenke always uses a product called BMP (bone morphogenetic protein) because it provides a faster, stronger fusion for his patients.  Dr. Lenke forewarned me back in September when we met that most insurance companies deny the BMP portion of the surgery.  Washington University absorbs the BMP cost.  My insurance has decided to deny the entire surgery because of the BMP; so they are not just denying the BMP portion but everything.

What makes things more challenging for me is that we must have some sort of "surgery only" approval from the insurance company today before close of business because of the holiday tomorrow and Lenke's office being closed on Friday.  The clock is literally ticking in the final countdown.  Jeremy has escalated as far as he can on our end and now we are waiting for Dr. Lenke to have the peer-to-peer chat with the insurance company directly.

I absolutely hate playing the "What If" game, but we need to be realistic at this stage.  If the insurance just doesn't respond today with an approval, everything is off and I'm back on the waiting list for a new surgery date.

Will keep you posted.


No comments:

Post a Comment