More Surgery for a Sweet Little Due

On Tuesday, June 26, Joshua had his surgery to get out the infection in his mouth. We had scheduled this date clear back when Joshua originally had his dentist appointment and Dr. Miller said he needed it. In the meantime, Joshua's secondary insurance denied him seeing the oral surgeon that we had previously gone to and who his dentist recommended. I appealed the decision - after all, this oral surgeon was "in network" for our primary insurance so the secondary would only have to pay a portion vs. paying more at a place that was "in network" for them. I was told the appeal could take a long time to process unless this was considered an emergency. Initially it wasn't. Then when he got really sick, I updated it to an emergency status and his pediatrician consented to signing off on my request.

I never heard back from his insurance company, and I was frustrated since I was calling in between doctor's visits and the hospital. When I called for the bazillionth time, I was told by a Member Service Rep that I didn't hear back on the appeal because they "dismissed it" due to approval. I asked her what the dismissal meant and she said "It's been approved that you can go to a non-participating provider." Great! Only they never followed through on telling the surgeon's office either. So, it was a mess. I called the insurance company even up to the day before and they assured me that they were taking care of notifying all parties. But, they didn't. It made me ANGRY! But, on the other hand, we are blessed to have this extra insurance for a little man who has needed it throughout his life. So, I try to remember that when I'm annoyed at dealing with them.

The surgeon's office "greeters" weren't too nice to us (an understatement). I realize, though, that they want to make sure they'll get paid. The office lady told me "Vicki in billing" wanted to collect money from us up front. I was about to tell her what she could do with that request when I realized it wasn't her fault either. On the other hand, our primary insurance pays 80% of the surgery, so why she thought she was going to collect payment up front was beyond me. They were paid for Joshua's last surgery by both insurance companies immediately, so asking to keep us (meanwhile, this was AFTER the surgery was performed and I was trying to leave with a very groggy Joshua was beyond me). Literally, as our child is there begging to go home, I called the secondary insurance company and put it on speaker phone so that she could hear directly from that member service person that it was approved - they would get the rest of the money that our primary insurance didn't pay from the secondary insurance. I wanted to lay into that front desk person and the person from the insurance company, too, especially when this is causing precious time when my baby isn't feeling well and needs to rest. They couldn't appreciate the week we had just gone through. But, getting mad doesn't help anyone either, I know. These idiots don't care about children or how their lack of doing their jobs well affects families. Such is life... in the end, we didn't have to pay for the surgery and Joshua got the care he needed. So, all's well that ends well, I guess. And I kind of think that what goes around comes around...

All that said, the surgery itself went extremely well, and once again we were impressed by his surgeon, Dr. Michael Eckert of Conestoga Oral Surgery. His skills and personality make dealing with his office staff worth the hassle. He told us how he had just gotten back from a missions' trip to Honduras where he was able to help those less fortunate, etc. He also talked to us about this very minor infection and his thoughts, telling us that with how small it was he didn't think it had anything to do with Joshua's recent illness and high fevers. We appreciated his talking with us and his abilities as a surgeon. He warned us once again that Joshua will need braces and a pallet expander like I had and most likely adult teeth pulled, etc. Yikes, buddy! I can appreciate what's in store for you! He told us to start saving our pennies (or thousands of dollars, I'm sure!).

Joshua did very well that day and didn't even need a breathing treatment upon coming out of surgery, praise God! (We had taken his equipment just in case.) We took it easy that day, but by the next day he was back to his normal and playful self. We even had a follow-up call from the surgeon that night asking about Joshua, and his office called the following day to see how he was doing. It was worth going through the appeal process to make sure Joshua gets the best care possible. He deserves it!

Please pray that there are NO MORE illnesses, sicknesses or weird infections with our oldest son! We pray for a long and healthy life for him!