Provisional yay

[monkey5s]

Got a call from the vascular surgeon's office today. Insurance HAS approved the varicose vein procedure. I told her I was a bit taken aback at the letter they had sent, rejecting it. Particularly the part where they stated I had not had the 3-month compression treatment. She said when she read that, she called them up and asked if they were crazy, since that was part of what she faxed them. They claimed they did not receive that page, so she asked if she could send them JUST that page? And so they have approved both veins on the right leg, but only the worse one on the left. (which... the left is the leg where the edema has made the skin break down, and only doing the one means edema will STILL BE A PROBLEM. Oh well.)

The provisional yay is because now I have to talk to the business office for the practice. This is so they can tell me how much I will have to cover, as in how much slack (between what they charge and what insurance allows) will they require me to pay. Not even including the deductible that the insurer will stick me with. So this isn't a done deal, but at least it's farther along.

Also, I am not sure how, if at all, this will affect my immediate problem, of the sore(s) on my bad ankle that heal as others open up. I'm running through all the first aid creams I can find, and so far the one that helps the most is a zinc cream I can only find at CVS. Oh well. Just keep plugging along.

Comments

[lavendertook]

I'm so glad, but I wish they were approving all you needed on both legs--can you appeal further?

Now that I've learned about these things, would an alternating pressure mattress pad help? And putting sheep skin covers on your joint points at night--the backs of heels are a major pressure sore risk, along with elbows and tailbone and hips.

*hugs*

[monkey5s]

Oh, I have no idea about appealing the provisional approval. I'll ask after I hear from the business office.

And the sore on my ankle is not a pressure sore (which, I have to say, is about the only good thing I can say for it!). The location of the current evolution of it is below my ankle bone, down to about a half-inch above the sole of my foot. It's healing from the edges, so is no longer a crescent of rawness, more of a shortened oblong. I'm still fighting the fungal infestation on the skin all the way up to my calf, but it's much better, too.

[readinggeek451]

I'm glad they saw reason. I hope you can get the rest of the money worked out.

It sometimes seems like insurance companies don't even read the details before denying claims.

[monkey5s]

I am pretty sure that an automatic denial of the first request is SOP for insurance companies. If you REALLY want it, you have to CONVINCE THEM you want it.

And we shall see how the money works out. As the woman from the vascular surgeon's said, the approval is good for one full year, so I can wait if it helps.