diary

My Surgery Journal

JUNE 2001 ~

I began this journey back in October of 2000. I had been looking on the internet for information regarding breast reduction for several months, and finally got the nerve up to make an appointment with a plastic surgeon. I've worked in the medical field before, so I knew a lot of our local doctors. I called up one that I knew had done some work on a friend of mine, and made an appointment. While I was on the phone making the appointment, I asked the girl, Shelly, some questions. She was very helpful and answered all of the questions thoroughly. I was impressed that she would do that before I was even seen. I received the preliminary paperwork in the mail, and off I went to the doctor.

I met with my doctor's nurse, who took a medical history, and then - after I changed - the doctor came in and explained the surgery, what it entails, and what I could expect. He said that there should be *no* problem with insurance approval, since he was confident he could remove more than 500 grams, which is what most insurances require for the surgery to qualify as "medically necessary." In fact, he said that to get me to a "B" (which is where I want to be) he'll probably have to remove 650 - 700 grams from each side. He does do the Le Jeour method. I've heard pros and cons about this method, but I trust his judgment. He's had a lot of success with it. I looked at his photo album, then Shelly took pictures of my breasts (eek!) to send with the pre-approval package to my insurance company.

. . . that was October 2000.

Since then, I've been fighting with my insurance company and jumping through their hoops. I'm still not approved, and it's June! I've come to the point where I'm going to pay for it myself if they don't approve it soon. We have the money in a mutual fund, so it won't be too hard to get it out. I'd hate to do that, though. I've sent the insurance company two letters from my primary-care doctor, and my P.S. has sent their package twice, the second time with articles and statements from other insurance companies where *they'd* paid. I talked with the girl from the insurance today, and she said it's still in "processing." I'm only going to give it a week or so before I schedule it on my own and fork over the money myself.

June 25, 2001
I was stonewalled by the insurance girl today, so I called my husband and had him speak to his boss. Our insurance is governed by a Board of Trustees, which are the individual owners of each union shop. They are working with a "consultant" from Arkansas BCBS, who reprices our claims. Hubby's Boss said that at the last meeting of the board, back on April 19, four women were requesting BR's and mine and one other was approved. The "consultant" was to take the pre-authorization packets back to BCBS and work on wording the acceptance letters so that the national union's Pension Board (which also governs our insurance) will know why they approved the surgery. I sent in my 2nd PCP letter, that they requested after the board meeting, on May 3. I'm going to wait another week and then I'll try to locate this "consultant."

July 12, 2001
Called Sheryl the Insurance Girl today. She said that she had "just" spoken with the "consultant" and he was getting something in the mail to me "this week." Didn't say whether it was an approval or a denial, and I was too chicken to ask!

July 16, 2001
Call from Shelly at Dr. Anderson's office. (I had called her on 7-12 to tell her what Sheryl had said.) Told her what I knew and asked what dates were open. She said if I get my approval in this week, she could schedule me for August 16 or August 23. :) :) :)

July 23, 2001
Still nothing from Sheryl or Consultant Man. Called Sheryl and she said she would call him. She seemed surprised that I hadn't heard anything.

July 26, 2001
Called Sheryl. (Why am I the only one who knows how to use a phone?) She said she had talked to Consultant Man, and that he was going to get something out today or tomorrow. I asked her if that was to HER or to ME, and she said "he wasn't real clear about that." I've resolved that on Monday, I'm getting his name and number and calling him myself. This has gone on long enough.

August 2, 2001

I AM APPROVED!!!!!!!!!!!!!!!!!!!
I was sitting at work typing, and my husband calls. He says, "I talked to B*** (his boss) and he said for you to call the doctor and get a date for your surgery. The doctor's office needs to call Sheryl and she'll approve it." I was, like, "Whaaat? Sheryl hasn't called me! There's no letter from Consultant Man!" He said that was all he knew. I called Sheryl and she confirmed it. BUT. . .she did say Dr. Anderson was out-of-network. I don't care! I'll pay the extra. I called Shelly, and after back-and-forth phone calls between Sheryl and me and Shelly and me, it was all set. I made an appointment for a "refresher" visit with Dr. Anderson for 8-15-01. They are scheduling surgery in September.

i'm on my way!!!!!!!!!!!!!!!!!! :) :) :)