Hi All, My pipeline stent procedure was scheduled for tomorrow. After all the pre-op testing and calling my Neurosurgeon's office daily for weeks, my insurance company denied the authorization of my procedure today. I have an unruptured 1.1 cm right carotid aneurysm near my optic nerve which was discovered incidentally when I tripped and hit my head, and fell (and fractured both my wrists) some months back. It's been a long journey through healing my wrists first, having surgery on one of them and through two excellent Neurosurgeon's consults, who recommended two different treatments. I also had a consult with a neurologist. I was in the process of deciding between clipping and craniotomy or pipeline embolization and was going to go through the angiogram before making a final decision, when the Neurosurgeon cancelled my angiogram and advised that they wouldn't accept my insurance plan (after they'd confirmed they would when I was purchasing it). It was very stressful and upsetting, as I'd done a lot of homework and had tried to make certain that both Drs would take the plan I purchased, so that that wouldn't be a consideration for me. I went back to my original Neurosurgeon who I also really liked and trusted, and he presented my case in a neurovascular conference, where the consensus was that I was a perfect candidate for pipeline. He had recommended pipeline from the start. After a lot of thought, reading and soul searching, and having my concerns addressed, I made the final decision to proceed with him and this procedure.
First it took 8 days for the insurance company to authorize the prescription that had been called in for plavix, so my treatment was delayed and procedure had to be re-scheduled right out of the gate. I purchased Empire Blue Cross Blue Shield, it's an HMO plan and I purchased it directly from them, not through the marketplace. When I was injured my position was terminated, and although Workman's Compensation took care of everything to do with my wrists, they finalized my case on January 31st and had made it clear to me from the start that because by all accounts my aneurysm pre-existed the injury, they wouldn't be able to cover anything to do with it. So as I dealt with the recovery of my wrists I dealt with getting myself insured as an individual. I have had what occurs to me like no end of delays and obstacles in dealing with this insurance plan ever since. It is expensive and more than I can afford, which only adds to the overall anxiety of the situation.
I called the Dr's office immediately when I finally got the prescription, as it was marked "no refills- Dr Auth required'. Basically I was told not to worry. As the days passed, I kept getting the same answer from my Dr's office about the authorization for the procedure- every version of "don't worry, don't stress, have patience, the insurance companies take time". Yesterday, at 48 hours out, I got impatient enough to say that I wanted an answer by day's end or a call from the Dr. Instead I got a call fI srom a nurse practitioner, apologizing but again pointing the finger at the insurance company, and another call this morning from an office manager, explaining yet again how the insurance company was dragging their feet but that I shouldn't worry. This afternoon the surgical co-ordinator calls to tell me that the insurance company is denying authorization, and that the Dr is getting involved, but in the meantime would I call the nurse at the insurance company and advocate on my own behalf as well? Of course I did, but the letter read to me by that nurse was ridiculous. It was explained to me that it was based on their policy that the procedure is considered "investigational". It also mentioned coil and stent procedure, which every specialist I have seen has recommended against, due to the fact that I have a wide necked aneurysm. I was surprised at how easy it was for me to speak to the other inaccuracies in the denial letter, but was left basically being told that I should let my family know it was unlikely that the procedure would happen tomorrow. Their Dr would call my Dr back for the peer consult call however she couldn't promise it would happen today. I literally begged this woman to do everything in her power to see to it that their Dr called my Dr back today as it was clear to me that this denial was not based on the facts as I understood them.
She would not give me their Dr's number and assured me that he had my Dr's cell and she would express all my concerns and let him know the urgency. Ultimately my own Dr called to let me know that he hadn't received the call and that they had left for the day at the insurance company side. He was definitely angry and still reassuring me that he would get this authorized asap.
I guess I'm wanting to know if anyone else has gone through this. While I'm not looking to point fingers and get into a he said she said situation, I do feel that my Dr's staff surgical co-ordinator didn't start early enough to push for the authorization so of course I can't help but be upset that I'm dealing with this the night before...however I'm far more upset with the insurance company. Investigational?? I am also left with the additional concern that once the procedure is authorized, I may continue to go through hell with each follow up angiogram and so on....
Any comments, info, experiences to share and or support would be greatly appreciated. Big thanks, Grace