An insurance update

I'm sure most of you are aware of my insurance woes, if not you can catch up on them here.

It was frustrating but I decided to play by the rules by sending in an application for appeal to hopefully get the knee covered. I talked to someone who had a similar operation (they had insurance) and they said their total bill came to about $45,000; definitely not something I wanted to pay out of pocket. I talked to my grandmother and got her involved in the case as well, seeing how I'm the worlds biggest procrastinator and I knew I'd never follow through with it on my own. She's great at this sort of thing and I knew she'd do everything in her power to get the job done-and document it. I receive periodic updates from her on how it's going and the occasional form to sign.

I've long since paid for all the testing/MRI costs out of pocket after they were rejected by BC/BS and knew the best I could hope for was for BC/BS to decide to cover my knee for future surgeries/injuries. I knew the chances of even that were between slim and none now that it had recently been injured. I couldn't imagine them stepping up to the plate to say they'd now cover my knee that was in need of surgery. Well, the other day just before leaving the library after checking my e-mail and updating my blog I got an e-mail from my grandmother. This is the letter she got from BC/BS-

We have received your request to remove the knee amendment on you. We are pleased to inform you that this amendment(s) will be removed for you effective October 1, 2007.

While future claims will be paid for the condition(s) in accordance with your current contract benefits, over the next several months, claims for services related to the condition(s) may be monitored. As stated in our certification letter, it is possible that additional medical records may be requested from the physician(s) at a later date.

Sweet! That rules! It sounds like they might be a little suspicious if I were to just show up at the hospital for surgery tomorrow but it sure is promising. It sounds like any future expenses on my knee will in fact be covered by BC/BS; but unfortunately it's not retroactive, which means I won't be re-imbursed for the expenses I've already paid for out of pocket. That's more then I expected though so I was pretty darn happy.

I was camping in the woods all weekend and when I found myself back in civilization in Montpelier, VT this morning I stopped by a coffee shop to check my e-mail (since the library here doesn't have free Wi-Fi!!). I found another e-mail from my grandmother titled “BC/BS Phase II”.

Expecting the worst I opened the e-mail and found she had now received this letter from them (readers digest version)-

This letter is in response to your July 25, 2007, and August 13, 2007, request for an appeal regarding your denied claims. The denials of these claims was based on the fact that we considered these procedures to possibly be in relation to the amended application you signed when obtaining coverage with our office.

A Wellmark Nurse reviewed the appeal and determined the claims for dates of service June 14, 2007, June 28, 2007, and July 5, 2007, are not related to the amended application on your policy. As a result of this review we have determined that these claims should be reopened and processed according to the terms and conditions of your benefit certificate. We have initiated the reprocessing of these claims and you will receive an updated Explanation of Benefits.

Holy smokes, you've got to be kidding me! Now I might actually get re-imbursed for the initial diagnostics on my knee, MRI included! This is just too much, it's money in the bank!

I'm trying not to get too excited because I still might not see a penny from it, but I'm hopeful.
Then to top all that off I then got an e-mail from my sister that someone had just bought my Saturn, which I'd left behind in Iowa hoping someone would come along and buy it. They dropped off a check and had the title. More money in the bank!

Man, this is just my day I guess. I was positively giddy after reading those e-mails. I went up and ordered myself a bagel breakfast sandwich instead of making my own food for lunch and followed it up with a hot chocolate and cinnamon roll. MMMmmm, delicious! The first food I've paid for (other then groceries) since I left Iowa a couple weeks ago.

If I was the type of person who believed it fate I'd have to think it was on my side right now. As it is I'll just take this as a reward for patience, hard work on my grandmother's part, and reaffirmation of my faith in humanity. Hopefully that won't be broken again when it comes time for surgery (whenever that may be).

Yippeee!!!