[Ouch!]

Well, to give an update. Tuesday the insurance company denied preauthorization for Prodisk, meaning they probably won't pay for it. I say probably because I do not have the letter from the insurance yet that tells me in writing the reason for denial.

B_ _ _ _ (name being withheld) that applies for the pre-certification, insists that the insurance is denying authorization because they DO NOT cover ADR. But 5 separate people at the insurance company have all told me it is being denied because Texas Back Institute will not give the insurance company the additional information they have requested. Insurance has said they have mailed me a letter & I have to wait until I receive it to do anything. They can't or won't fax the letter to me.

I spoke with several people at TBI Wed. morning. They want me to send them $19,000 right away as they are supposed to have this 2 weeks before surgery (My surgery is supposed to be next Thursday July 19.) Also the hospital wants me to immediately send them $14,000 just for the disk & they have agreed to bill me for the rest.

I told TBI, that since Dr Zigler has said that he will not know whether he will be able to do the ADR or whether he will do a fusion until he gets inside to the back, that I wanted them to get authorization for the fusion. If I end up with a fusion because Dr. Zigler can't do the ADR I sure don't want to pay out of pocket!

They applied for that authorization at noon Wed.

So, now I am waiting. Insurance has told me I will know Monday whether a fusion is approved. I really want to get the original denial letter before I go ahead with any surgery. If it says they don't cover ADR, fine, that is the end of that. BUT if they say it is denied because they need more information, then I want them to have that information & make an informed decision before I pay out of pocket.

To say I am angry at the situation is an understatement. It is not just the rush to get insurance settled or pay TBI right away. (If I pay out of pocket, we will be borrowing against our house.) Both my husband and I rearranged our schedules and gave up contracts that would have meant income to us for me to have surgery next week. It isn't like we can get those contracts back. They are gone, lost income. Now if there is a delay for the surgery there will be more lost income for my husband when he takes off to go with me for surgery. But we won't know about the insurance until we get the letter. If they need more information, will B_ _ _ _ be willing to get it to the insurance co since she has not been very co-operative so far?

At this point, even though I was impressed with Dr. Zigler, I am not sure TBI is the place to have any surgery, at least for me. I am also having problems getting motivated to pack & get the last minute things done before surgery. Now, I don't even want to go off the meds I am supposed to stop a week before surgery because, what if surgery is delayed.

We are scheduled to fly to Texas Tuesday morning. So, I hope I get the insurance letter soon, though I am not holding my breath because I know it usually takes about a week to get any letters from them once they have mailed them out.

Sorry to be so down, but it really is disheartening to think things are settled, surgery is soon & you will be on the road to recovery and then have it all change.

Jane