The Plot Thickens

I thought at this time today I would be 8 hours into a 12 hour surgery and not sitting in a coffee shop typing this. Yesterday at 4 pm my Boston doctor’s office received notice from my health insurance company that they would not cover any of my amputation costs. Two months ago my insurance had told them I didn’t need prior authorization for out of network care but had failed to mention that was because they wouldn’t pay for any of it. My Health Partners insurance is through the state of MN and usually state plans are less generous out of network but the Boston team said this is the first time they have encountered one with zero out of network coverage.

I received the call from my doc’s assistant Lori while waiting for my parents to arrive at the airport. I told her that I would still go ahead with the surgery and would just have to figure things out after the fact. When my parents arrived they agreed that there would always be a way and didn’t seem phased by the new development. We went back to the apartment we had rented for the month. Mum and Dad went out to eat and I went to bed. I wasn’t really getting good sleep and thankfully I forgot to put my phone on airplane mode (which I usually do when sleeping) so when my doctor called me from his cell I answered it. Dr Carty had just heard the news because he had been in the OR all day and he informed me regretfully that we would have to postpone the surgery. He said that ethically they couldn’t burden me with what would be a bill upwards of $100,000, in a best case scenario! From a purely business perspective it amounted to the hospital giving me a very large loan I doubt they wanted to do on 14 hour notice.

We met with his staff at the clinic today. They had submitted one appeal to Health Partners that was denied, but have found a different way to approach the issue and have submitted a second appeal already. If that appeal fails we can take it to the State, but this process can be slow as I discovered last year when I went through it trying to save my knee……. but that’s a whole other blog post.

I am going to look into getting a private insurance policy that will cover a high percentage of out of network costs so if anyone reading this has experience or works in the belly of the health insurance beast I would love some advice or recommendations. There are also some other options Dr Cartys’ staff are aware of to get funding support and together we will pursue each one until the right doors open.

On a personal level I am obviously in a state of shock and in a bit of a haze. I was pretty exhausted and ready for a couple weeks of enforced rest and government heroin after all the work it took to arrange life for this to happen. I’m going to enjoy a few more days in Boston with my parents before I head back to real life in Minnesota again. Next time we come back here, hopefully within a couple months, we will be even better at it, thanks to our dress rehearsal. I am also overwhelmed by all the love and positivity I have been receiving from so many friends and family at this time. Thank you all.

3 thoughts on “The Plot Thickens

  1. I love you bro, All things happen for a reason but you know that better than anyone I know. I’ll be praying for you and yours.

    Kris

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  2. What a frustrating development! I can’t imagine how hard it is to get set for such a momentous surgery, only to be denied! You are being a champ, as always. I will hold the futile anger at our broken health care system for a bit. I have some good scarring and calluses from some very scary delays and close calls in Megan’s treatment.

    Thanks for the update. Hang in there 🌳🌿🙀

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  3. Hello, Robin!~
    Have you explored the option of a health-sharing program instead of insurance at all? I am part of one called Samaratin Ministries (there are faith-based ones and ones that are not faith-based), and I’ve always had all my medical needs covered with it; though I don’t know the details on if they have a cap for expenses, it would be worth checking out, I think. Grace to you.

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