Mail Call...

I've been pretty fortunate when it comes to my insurance.

(Knock on Wood)

I think we've all heard stories where people go into the hospital to take care of a medical problem only to find out later that it wasn't covered.

That's actually been a fear of mine going into this 2nd surgery. As you know, some people keep the hardware in their knees. So I guess this could be classified as "elective surgery" in some circles.

Why would someone choose to do that? Well, I think it depends upon their age or level of activity. Maybe they just don't want to go through another surgery...

For me, it wasn't even a difficult decision: Those wires were coming out!

I guess I had two main reasons for having them removed. First, they hurt. I was limited in what I could do each day because of distances - if I felt that it was a long walk, then I'd pass. If I felt that it would be a lot of effort, I'd decline. Each time I took a step, the wires would move along with the kneecap... up and down... to the point where most days the knee was swollen.

The other reason is my mobility was hampered. It was incredibly difficult to go up or down stairs. My doctor also advised me not to do anything strenuous... so I couldn't exercise. And, in some circumstances, the knee would actually "lock." I'd have to stop walking... something wasn't right. And I knew that because it was rubbing against something...

We scheduled the surgery a week and a half from my last visit with Dr. Rutherford. I figured I'd hear something from the insurance if there was a problem... nothing. Well, not exactly. I heard from my the nurse that works for the insurance company. She called to check on me before, and told me that CIGNA was reviewing it as "pending approval." I asked what that meant, and she said they were just getting more information from my doctor.... "Nothing to worry about."

(Knock on Wood)

So after a few days at the folks, I returned to a mountain of mail sitting in my mailbox. I saw there was something from CIGNA... hmm... whatever could it be???

Oh, it was just a simple letter letting me know they are denying the following coverage: Inpatient level of care

"From the clinical information received, medical necessity for coverage of an acute inpatient hospitalization for the Removal of Support implant being requested has not been established. The procedure itself which is being authorized is routinely performed as an outpatient and no documentation has been received detailing a clinical condition or significant comorbidity that would warrant an inpatient admission for this procedure. However should admission to an inpatient service become adviseable or necessary because of unexpected findings or complications following the Removal of Support Implant, this will be reviewed on a concurrent basis following surgery."

OK... when I first read this... actually, the first few times I read this, I thought, "What the hey? They aren't covering this?"

Then, it hit me... "Oh... they're saying that if I was admitted overnight, then that wouldn't be covered." Good thing I didn't have any problems... otherwise I might have had a big headache in the months afterwards with my insurance company.

So that's what I'm taking from this - that's the explanation for how I'm interpretting this language. If you, my more experienced reader, think otherwise, please let me know.

I'm just ready for all of this mess to be over with...