"Ms. Wagner, since the coverage from your insurance for your surgery is 'pending', we can go ahead and take you back and start getting you ready for surgery." the desk lady at the hospital informed me.
"I decline to begin any procedures until coverage is confirmed by my insurance." I answered, as politely as possible. I kind of pushed my ass a little harder down in my chair in the surgical waiting area.
The lady let out a little sigh.
"Don't blame you." she replied.
"I decline to begin any procedures until coverage is confirmed by my insurance." I answered, as politely as possible. I kind of pushed my ass a little harder down in my chair in the surgical waiting area.
The lady let out a little sigh.
"Don't blame you." she replied.
It all started on Thursday afternoon, the Thursday before my Tuesday surgery appointment. The appointment that was booked in July. The one I made a special request at work for during the first week of school, so that I could get days off ahead of the Thanksgiving vacation - "critical days" - the ones you don't get paid for if you don't come, no matter how many sick days you've banked. The appointment I already got blood work done for, unfortunately out of network, for over four hundred dollars. And took time off of work for. The appointment I had already paid a "surgical fee" of almost eight hundred dollars for. And bought a bunch of knee scooters and bullshit for another hundred dollars so that I could get around for two months, post-op, on one foot. And had left work early, gone to my pre-op appointment at the hospital and spent days washing and soaking myself with some awful antiseptic wash they made me use for days. For that appointment, the appointment I had prepared for, my Tuesday, November 19th surgery appointment.
"As you are aware - your surgery was denied. I'm not sure why. This hasn't happened to me in 15 years. So I have a peer to peer on Monday morning." the surgeon's message stated.
"Aware of what? It's canceled? Who was supposed to tell me this?" I responded, while watching some kid that spoke Arabic try to do science.
"I thought the message was from you," he responded.
"But it's from Piedmont. Your insurance is denying coverage."
"I think it's a technicality." he explained.
"Please let me know on Monday what is going on." I responded.
I looked at the water cycle assignment. How the fuck was this happening?
I spent the rest of the day pretending everything was going to be fine. Preparing sub plans. Talking to my mom's doctors about her transfer to a rehabilitation facility. Doing things at home that I might not be able to do on one foot. I had appointments for my mom's dog the day after my surgery, he needed his shots and someone to look at this growth on his neck. I had a lot of things to think about.
Monday was my last day at work for nearly two weeks. I watched my messages like a hawk, waiting for the doctor to tell me how it went. Late in the day, I got a message from his office that "everything was fine". I smiled and drove to the Farmer's Market. I was going to need food for the next week or so. By the time I parked the car, I asked myself if I had lost my mind and called the doctor's office to get them to clarify.
"Hi yeah, you've paid us!" the receptionist responded when I asked for clarification on their message.
"Yeah....I know that you guys got paid but I need to know the results of the peer to peer." I answered.
"Hi yeah, you've paid us!" the receptionist responded when I asked for clarification on their message.
"Yeah....I know that you guys got paid but I need to know the results of the peer to peer." I answered.
"Oh. Okay. I'm going to put you through to Piedmont billing." she said, a little edge to her voice.
"No. No, I'm good. Ask the doctor to send me a message on the results of the peer to peer." I said and hung up.
I called my insurance company. I was on hold for almost an hour. I sat in the car, watching people coming and going with their groceries.
"Blue Cross Blue Shield!" someone finally said.
I explained that my doctor's office said that "everything was good" and asked some questions about how they would apply the money in my spending account to all these bills, why my estimate of benefits was saying I was going to pay more than $26,000 in the morning, my special price because I have insurance but they won't pay....why I hadn't received an updated EOB.....
"Hey," the lady said.
"This thing is still coming up as pending....."
I saw my doctor calling on the other line. I hung up and answered him.
"So, the peer to peer went through. They had old x-rays. But now, now there is a problem with the code...."
"WHAT?" I answered, watching the sun go down on the Farmer's Market parking lot.
"I think it can be fixed, but....is there any way we can reschedule?" he asked, his voice super hesitant.
"No." I whispered.
"We can't. This is bad."
"Okay." he answered.
"You were going to be first in in the morning. I'll move you to second and try to get the code through in the morning."
"Okay. Thank you." I responded, feeling sick to my stomach.
"So I come at eight instead of five thirty?"
"Yes."
I hung up the phone and tried to start the car. There was no way I could grocery shop at this point. The battery was dead, it wouldn't turn over. I had left the lights on.
I got out and walked inside and bought vegetables.
And olives.
I was limping a little. Because my foot hurt. The foot they were supposed to fix.

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