Awesome.

Nothing has happened since last week. Our phone calls and emails have not been returned yet.

One step forward

Yesterday I was bummed out all morning and I kept going over and over all the details in my head trying to figure out why all this happened. When I think back I can remember some vague remarks that I think were intended for me to get a general idea of some costs, but not really. I think if we're dealing with big numbers there should be some kind of financial plan on paper saying what will be due on what date and what it's for, etc. We were just throwing out numbers here and there and it was all uncertain and incorrect anyway. THE GOOD NEWS IS: I got a call from Rachel yesterday and she said that Dr. Franco finally did get a call from Cigna for the Peer to Peer and they were able to approve me! Yay! THE BAD NEWS IS: Cigna doesn't cover TMJ which means they will not cover ANY of the hospital costs if he works on my TMJ durning the Orthognathic surgery which was approved. THE SOLUTION: Dr. Franco suggested that we do the Orthognathic surgery only at the hospital. Surgery and hospital is covered. After a month or so, do the TMJ surgery out of pocket in his office which would be much cheaper. It saves over $20,000 if we do it that way. The downside is that I have to have 2 surgeries, which means more pain, more time off from work, etc. But, it's probably the best way. We were able to get me rescheduled for March 26. Lets see if it sticks this time!

Surgery Postponed!

Today is my surgery day. As you are reading this you can correctly assume that I am not on the operating table. Yesterday morning Rachel calls and tells my mom that Cigna stood up two appointments with them for the peer to peer review. She claimed that they called and called and no one would talk to them. In my opinion, this should have been done weeks ago, not the 24 hours before surgery. There was an exchange of about 40 calls between me, my mom, Rachel, Cigna and Baylor Hospital with every roadblock you could imagine. In the end the result was that with or without Cigna's help I would still owe $19K and change on the day of surgery. This is because of TMJ fees being charged out of pocket. I paid for the TMJ surgery but there are separate fees the hospital gives you. This was never told to me. Rachel claims that she discussed it with me. She didn't. I think I would remember if she had said, "You will owe 19K on the day of surgery." In one of the conversations we had yesterday, she said "I'm confused because it's the same with all our patients that a down payment is due and I thought we discussed the 28K?" I said, "Yes, we discussed the $28K (which was wrong by the way) and you said I could work out a payment plan with them. 19K was never a number in the mix. A huge deposit was never discussed." I've never had surgery before and I relied a 100% on her to give me all the info that I need. After I learned that it was 19K down, I sent her an email and she acted shocked. She said that "She'd received my scary email." She acknowledged that the price wasn't right. She called Baylor after we talked and said they coded the surgery wrong. So...why is she mad that this was a surprise? She's acting like it was a surprise to her too? We need another week at least to borrow the money. I hung up with her and she called my mom. She told my mom, "This is kind of a big deal that you're canceling the day before." But there is nothing we can do. This deposit was sprung on us at the last minute and she didn't work out the peer to peer. We asked to reschedule and she said Dr. Franco doesn't have another opening until May. She said that she won't book another OR at Baylor until we pay everything up front. Too bad she wasn't that clear and forward a month ago! I called Cigna this morning at 6am and wanted to get my mom, dad and lawyers names on the approval list to talk to them and they said I had to fill out a form and send a fax that would take 3-4 weeks to process. There is no way to verify that they received the fax. So nothing is rescheduled, I didn't have the surgery, I lost 2 months of supplemental income for an ESL class I teach and I had to fire that girl that was covering me for the next month.

These people are causing me to overeat

This morning at 9am I showed up to Baylor for Pre-Admitting. My boyfriend and I walked there from our apartment. It was such a beautiful day, pretty much perfect weather. We signed in and waited only about 10 or 15 minutes. When they called me back we sat with a billing woman named Natasha. She entered all my information into her system and then looked confused and said, "What did your insurance tell you?" I told her the story and she said that we have to pay the $19K. Now it's $19K. Two days ago it was $15K and tomorrow it will be something else. She said that if the insurance didn't accept the surgery then we could post date the payment and have 2 weeks until it withdraws. But still...that's not much help. We didn't even do the physical, we just left. I called Rachel at Dr. Franco's office and she said that they were trying to get that peer to peer review but Cigna wouldn't call them back. Then she said that they'd finally called and said that the guy that he needs to talk to only works on Wednesdays. But, the surgery is on Wednesday. So, she said that they will have him call in before 5pm. So, I went on about my day. I went to the dentist and got a cleaning. I also renewed my driver's license which will expire next week and got my car cleaned. We ate brunch in a really cute courtyard and dinner at a really yummy Asian restaurant.

The Most Annoying People Ever

Cigna has not approved my surgery fees yet. With that being said, I've paid out of pocket in the hopes of them covering it at the last minute. Last week the woman who works at Dr. Franco's office in the business office tells me that the estimate for out of pocket without insurance paying is $28,000. It's a hospital so I can set up a payment plan, etc. I've already paid for the surgery separately. It's kind of generally understood that hospitals will work with you on payment plans and negotiating the bills. Yesterday I got a call from the woman at Baylor Hospital in their business office. She tells me that the estimate is $61,000! And that I owe 60% at the time of services. That's kind of a huge bomb to drop on someone a few days before their surgery!

It was late so I wrote an email to the woman (Rachel) at Dr. Franco's office who is his business manager, she tells me that when she got the estimate from Baylor they told her if insurance doesn't pay, it's $28,000. She calls them and they tell her "whoops, we coded the surgery wrong". Now, I am really in a bind because I'm expected to show up on Wed. with about $15,000 cash. $61,000 - 35% (no insurance discount)= 39,000 they want 20,000 but will take no less than 15,000. Rachel also tells me that Cigna doesn't even have my X-Rays yet! She faxed them and they received them solid black so she mailed them and they haven't seen them. She set up a peer to peer review with Dr. Franco for Tuesday. Ha! So, I guess I won't know until Tuesday afternoon whether or not I'm having surgery Wed. morning. On a side note I'm finished with work. They brought in another person to fill my position for the next month. This is ridiculous.

Stocking Up

On my last post I titled it "Post Op Rush" but I meant Pre-Op. I was really tired, sorry. I haven't had my surgery yet, just to make that clear. Dr. Franco told me to start taking Arnica pills today. You can buy them at whole foods. They are for muscle pain, bruising and swelling. He also told me to buy Calendula cream. I suppose I'll use that on my face after surgery instead of my regular face cream. I also bought about $80 worth of pureed soups by Pacific. I like that brand because they're low in sugar. I don't want to be lying around in bed for a month drinking sugar. They also have low sodium options for a lot of their soups. Sodium is bad for swelling so we don't want that. Finally, I ordered a bag of collagen in powder form--it's good for healing bones and hair. Dr. Franco said some of my hair might fall out! I'll put that in my drinks. Whey Protein is good for shakes but is has a vanilla flavor so it's not good for everything. That's it for today! Have a great day!

Pre-Op Rush

I was supposed to visit Dr. Franco tomorrow but they called and had me come today. I had to pay 1/2 down. By "I" I mean my mom. I signed some waivers. Do I agree to have blood given to me if I need it? Yes, but asked if the blood could come from my dad if I need it. He's my blood type and he's my dad so I felt like it was less gross. Dr. Franco said that it's not likely that I'll need any anyway. Do I agree to let Baylor take the body parts or fluids that they take out? Yes. Do I agree to allow video or photos to be used by Dr. Franco or Baylor? Yes. He said they're not taking a video but some students want to watch behind a glass. Yes, that's fine. Some of the side effects page scared me. It mentioned dead lips forever, pain forever, wonky bite, etc. Oh, and of course paralyzation and death. But I think those are all worse case scenarios. Dr. Franco assured me that none of his patients have had those things.

Dr. Franco said, "Please Please Please don't blow your nose." He's told me this before, so I know something bad could happen if I do. He said no breathe right strips. He said not to eat dairy if I can help it. He went into some detail about the procedure. The TMJ part is first - through the ear he'll rebuild and basically nail in the disc to each side. Then he cuts the tissue above the gum line and pulls upward to make the incision from molar to molar. The entire top jaw comes out and forward, and he'll expand through the center (palate) to make it wider. Then the lower jaw will be cut behind the wisdom teeth and pulled forward. He said that here, he will make tiny incisions through the outside skin itself. So, I will have a small blue stitch on both sides of my jaw. But there won't be a scar. That's the gist of it! Finally, we talked about some after surgery side effects such as depression, insomnia and stomach problems. I'm supposed to keep him in the loop about any emotional problems I have.