Wednesday, September 12, 2007


Happy Mommy!

We received just about the best news that we possibly could--insurance preauthorization for Miles' surgery! We now have our plane tickets and we are really going to do this. Yikes! After months (really years) of worrying about getting insurance approval, and then 24 hours where it did not look good, it happened.

Follow up from my last post where B talked to the doctor's office and they said the insurance company didn't preauthorize outpatient surgeries: I called Dr. R's office and finally got through the next day. It sounded like she hadn't talked to the people at the number I had given her. It turns out I was right. I first looked in my benefits booklet and found that it specifically says that reconstructive surgery must be preauthorized. I then called my insurance company. They said that yes, it must be preauthorized and that they kept a log of all calls and there had been no calls from anyone about Miles. It turns out that Dr. R's office was talking to the CA branch of the insurance company. Duh, each state has different rules.

I then talked to my PAL rep. She recommended that we go ahead and get tickets and do the surgery. She said that even if we didn't get pre-auth and had to fight the insurance company after the surgery, she felt pretty sure we would win, since the surgery is to correct a birth defect. I also talked to the people on my microtia board. I found out that Dr. R's office did the exact same thing to someone on there that recently had surgery (i.e., called the CA office, rather than her state office).

I then spoke to Dr. R's office and she was going to talk to my state insurance office. I waited on tenterhooks, expecting the worst and then boom! Suddenly I received an email with a preauthorization number! I was so happy that I cried, and I mean bawled like a baby. I was really surprised that I reacted that way. It was like one of the biggest loads lifted off of my shoulders. Such a wonderful feeling. time to stress about the surgery! I just wouldn't be me if I wasn't stressing about something.

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