Like Tom Says - The Waiting is the Hardest Part

Health insurance is a blessing. It allows a person to improve their quality of life. It can also be a huge, frustrating mess to deal with if you actually want to use it. Our daughter's health insurance comes from a large, well-known insurance provider. A large, well-known, slow-to-decide, difficult to talk to, insurance provider. I was a little intimidated about getting out-of-state surgery approved. I thought I would have to do most of the begging.

Once we had decided to do this, there really wasn't any turning back. We had our minds made up, and we were going to find a way, even if it meant knocking on the doors of strangers. As we began the process, the staff at the doctor's office explained that they would be making all the arrangements through our insurance company. I was relieved at first, but, let's face it, I'm a control freak. If you hadn't figured that out yet, you may need to read more closely. It's hard to sit around and wait while strangers decide fate of your kid. I mean, I know she's this awesome person who deserves the life she was intended to have. But, do they? Do they know she loves dogs and balls and babies - and that all dogs, balls, and babies will be better off for having played with her? I was just afraid the insurance would turn down this relatively anonymous, invisible kid. And then what was I going to do?


I wasn't able to let it be, and my sweet husband was a good sport. He would call the doctor's office as much as I asked him to. I asked him to a lot, because he's better at it. And he certainly won't burst into tears at any given moment. We learned a lot of things as we waited. 1.) The cost of BPI surgery is astronomical. It would take years and years and years to raise that type of cash to pay for it yourself. 2.) That there are avenues to take if you don't get approved; it's not the end. 3.) You might get approved, but it might be out-of-network, costing about twice as much.


It's kind of like unravelling a ball of yarn. Sometimes it goes really fast, and sometimes it goes really slow. Sometimes you get stuck for awhile on a knot, or you can't find the right trail. The waiting, for me, was the worst. We would get a lot of reassurances from the nurses that it just takes awhile, and they were really great at keeping us updated. Probably because we wouldn't leave 'em alone.


We went to our pediatrician to get a referral for the insurance, in case they asked for it. It was a weird visit. Basically, he had said he wouldn't give us a referral without talking to us, so we had to pay the $25 bucks it takes to see the doctor. He was supportive right away, so I think he was just being nosy. He is obsessed with Dr. Nath's website. He thinks it's this wondrous place of high-tech-ness or something. He kept saying "cutting-edge" and making other excited utterances. It was funny. He did offer some valuable tips on travel and post-surgery care, and he continues to be very interested in my child's progress to this day.


It seemed like every day we got something in the mail from the insurance company. Jerks. Never the thing we were waiting for, but letters and mailings that said things that sounded promising. We began to brainstorm ways to make money. Garage sales, concerts, events, collection cans, car washes. It would take a lot of car washes. And that was just for the first surgery. We need three. There is really just no realistic way to pay for this out of pocket, unless you happen to be a frequent dinner guest of Brad and Angelina.


What we were waiting for, it turns out, is a negotiation. This insurance company operated differently in our state than in Texas. So, he was not in network. IN OUR STATE. But, he was in network for THE SAME company in his own state. That seems like it would be easily transferred, but that is not the case.

As it turns out, technically anyone can see any doctor on the planet they want, if the stars align and everyone involved is in an agreeable mood on the particular day of the negotiation. As I understand it, the doctor asks the insurance company to please allow you to be his patient. Then, the insurance company says, "Well, maybe, honey, what's your bottom line?" The doctor says he wants to get paid $XXXXX.XX. Next, the insurance company says no way, that's too much." The Doctor lowers his cost, and a marriage is made. The doctor signs on the line, the insurance raises your premium, and next thing you know, you are stuck in an airport for 12 hours, clutching the checkbook that is the direct line to every last penny you have, soon to be given over in gratitude to a man who will permanently scar your child. All that hard work, anticipation, unravelling, was worth it.