Biacuplasty, revisited

[ERvet]

Not quite the title of a best seller....

It seems Blue Cross has given the go ahead for me. Actually what they said was, "Oh, you don't need a precert for that, just go ahead." I figure they also put in invisible ink, "but we may not pay for it." I'll find out. Planning on scheduling this as soon as I can coordinate with my other ER docs at my hospital. I'll let you all know how it turns out.

I'm in Florida right now, at a rather large veterinary conference. Orlando seems kind of a silly city.....lots of hotels and restaurants. Haven't seen much else. I assume there are people that actually live here?

Ciao
Susan/ERvet

[ERvet]

Well, Feb 9th is the day. I'll have to learn a few new colorful metaphors....I'll let all y'all know how it goes.

Susan/ERvet

[Harrison]

Sue, good luck with your procedure next week. Please keep us updated with the details as you learn more.

[ERvet]

Originally Posted by Harrison

Glad you survived Orlando

Harrison:
Survived is the key word here. What a very silly place! What was absolute torture were the flights to and from, and sitting in lecture halls for 6-7 hours a day. I will let you know how the procedure goes, and if I learn any new words.
The part I dislike is stopping my NSAID for the week prior.....I can tell after about 48 hours how much it actually helps. I've got 5 shifts to work prior to taking a week off.....

Susan/ERvet

[CharlesinCharge]

Susan,

I will be very curious to see how the Biacuplasty goes, and if your insurance pays for it. As you know my Pain Management doctor wanted to try it on me, but Blue Cross PPO refused to pay for it. He did admit to me that in trials it only had about a 40% success rate, but since it cannot do any harm or preclude you from future surgery, it is worth a try. Best of luck with the procedure.

[ERvet]

Originally Posted by CharlesinCharge

Susan,

I will be very curious to see how the Biacuplasty goes, and if your insurance pays for it. As you know my Pain Management doctor wanted to try it on me, but Blue Cross PPO refused to pay for it.

Charles: interestingly enough, I have BC/BS, which I am learning to resent mightily.....and they apparently told my doc's med assistant, "oh, you don't need pre-authorization for that, go ahead." I was floored. I figure they misunderstood. But she's got it in writing, with names, dates, etc. So we shall see. I will post an update next Monday, when I get home. I figure on being thoroughly bored during the week.....I'm apparently a workaholic. I'll have to do my taxes or something. Catch up on 24 and see what Jack Bauer is up to, not that he ever has time.

Susan/ERvet

[ERvet]

WELL.......
that about covers Blue Cross. Got a call from my doc's med assistant this morning. Seems that Baylis (biacuplasty company) wants to be sure they get paid, and you go through their approval people to be sure insurance is on board. Apparently Baylis called this morning and told doc's office they need more information.....presumed because BC is giving them a hard time. So the procedure has been delayed until that happens. Figures. It all sounded too good to be true. And here I was ALL ready to learn some new colorful metaphors! So I'm back on my NSAID, gonna NOT do my taxes next week, and catch Jack and 24 on my DVR. I'll let you know if/when I get this procedure approved. At least I've got some folks on my side going to bat for me, if only to ensure that THEY get paid. Pretty good incentive for success.

OH, and one more thing, BC: :flam ing:

Susan/ERvet

[ERvet]

Kimmers: I actually had someone in my company's HR department tell me, "I'm sure they make decisions based on your best interests.." I certainly gave HER an earful.....yeah, don't get me started on BC. I'm hoping the company marketing the biacuplasty is working REALLY hard to get this approved. I am assuming they are what is behind the "further information needed" that my doc's assistant mentioned to me this morning. They would certainly have a big incentive to get insurance companies to pay for their product. At any rate, I sit and wait, back on my NSAID, and working two ER shifts this weekend.


Susan/ERvet

[ERvet]

Well, we are going to just get 'er done. My doc's assistant and I chatted yesterday, and the "final" answer from BC/BS was they would evaluate the claim when it was filed. Sooooo, they didn't say NO, outright. "Medical necessity" was mentioned, and my doc's assistant tells me, and I most certainly think she has an excellent point, that I have done everything BUT surgery to relieve this pain, and what else is there to do? She thinks we can make a good case for medical necessity. At the least, I think they can work with me a little, and BOY am I ready for a fight! Baylis Medical will certainly help, so at least I've got someone on my side. It is scheduled for Monday, Feb 23. At our new regional hospital, which is QUITE lovely on the inside. Looks like a 5-star hotel when you walk in! So I'll let all y'all (that's the plural of y'all, y'know) know how it goes next week.

Practicing up on some new colorful metaphors.....
Thinking up some tunes to commemorate the occasion. So far I've got "Ring of Fire".....anyone else have any suggestions for some appropriate musical interludes for a radiofrequency procedure?

Susan/ERvet

[Harrison]

Sorry about the news, Sue. I am glad you still have your sense of humor! It's an invaluable tool for coping with stressful news...

Ring of fire?! That's priceless. I can't top that! Good Lord, Sue. What are you doing for meds these days?!