The day has finally arrived. We're headed to Tennessee to see if that's where we want to move. It seems nice there and we're hopeful that we'll like it, because we want the kids to be much more "outdoorsy". All you can do where I live is go to the mall or play on a city park swing set.
I'm not looking forward to the trip because I'll be sitting a lot and driving some. Those don't work well for people with post vasectomy pain syndrome. Something about being all bunched up for so long. So I'll probably take some tylenol or ibuprofen before we start on the trip.
I spoke to the insurance person yesterday again! Ugh, how frustrating. The lady told me that it was their human error for sending out the predetermination letter stating the reversal would be an eligible claim per our health plan. Can you believe that, AND then she told me that the approved predetermination letter (to make sure the surgery was covered by the medical necessity clause) and verbal commitments by their authorized representatives, were non-binding. She states that it says very clearly in the health plan that reversal of sterilization is not covered. However, I told her the plan also states very clearly that if a procedure is deemed medically necessary (which is why we were told to do the predetermination), then it is clearly covered. Add to that the predetermination letter and the verbal commitments by their agents stating that the medical necessity clause of the plan had been met and as long as I followed the other rules, like making sure we used the right doctor, facility, and coding, the surgery would be covered.
So when she told me that it was their human error and that they should never had approved the predetermination, I knew it was no longer my problem. However, she then told me that because we had already gone through the first appeal, it was too late for the insurance company to do anything about it.
Sounds kind of weird huh? I thought so too. I wanted to get this recorded somewhere, so what better place than my online journal. I think something good may have come out of the call though. She will try to set up a phone call between their appeals medical director and my surgeon. I'm not sure if anything can come of that, but at least it's a start.
As far as how I feel today goes, I guess I'm doing okay. No major aches or pains.My left side is still a little achey, like it could hurt really bad at any time. I've had a little nerve pain on my right side, but nothing too terrible. Of course, I was also pretty sedintary yesterday. I think I'll try going for a walk on the treadmilll today before our trip. Nothing crazy, just kind of like a liesurely stroll.
I guess that's all for today, Lord willing. I'll return to the blog after our trip.