Steven's Posts

So, it's been over a year since my valve surgery. Generally speaking, things have been going quite well. But the last few months I was starting to have some shortness of breath that I couldn't blame on being out of shape. So off to the cardiologist we went. After an EKG and an echocardiogram, they decided I was back in atrial flutter. I had a MAZE procedure and I've been cardioverted twice since my surgery. But apparently it just isn't sticking. So next week I'm scheduled for a transesophageal echo (TEE) to make sure there's no clots, then off to the cath lab for an ablation. This seems like the best option, and hopefully one that will result in a sustainable outcome.

A quick update, it's been four months now since my surgery and I think I've progressed very nicely. I've been diligent about the treadmill work and I've become a disciple of the low-salt diet. My energy level has been good. Confirmation medically of my progress was given to me last week after I saw my cardiologist and after my first echocardiogram post-surgery. I got the results yesterday and my ejection fraction was 55%! That's fantastic, since in January it was 25% and right before surgery is was about 35%. So definitely progress is being made. Next I see an electrophysiologist since I'm still in an irregular heart rhythm. Hopefully that will resolve itself somehow. Next week I'm off to Ecuador for my daughter's wedding. A long flight, but I should be good to go now.

Something that I was certainly concerned about was the fact that we went out-of-network for my surgical care. Like most of us that have gone through this, I was one of those that thought "I'm going to find the best possible surgeon and facility that suits my particular situation". Well, my research told me that Dr. Bolling and the University of Michigan was the right ticket. But my insurance company didn't seem to agree. Here's a chronology of events relative to my insurance issues. Two months before my surgery, after consulting with my cardiologist, I had a letter sent to my insurance company requesting in-network benefits for a distant referral to an out-of-network provider. Of course, they denied in-network benefits immediately, but to their credit they approved out-of-network benefits. But in reality this wasn't much a stretch since they were required per my contract (through my work) to allow me to go out-of-network at my discretion). But we were rather determined that this surgery should be covered with in-network benefits, so we appealed their decision. I received their denial of appeal the day I traveled to Michigan to have surgery. During my recovery time at home I filed for a second appeal (required by law by my insurer) which afforded me the opportunity to either provide the appeal in writing or appear before their Appeals Committee to make my case. Because I'm rather stubborn, I chose the latter. I formulated my arguments during the time I was recuperating since I had lots of computer time on my hands. On June 1st, my wife and I went face-to-face with a committee of three who were to decide the merits of my arguments which were based on clinical need, the inappropriateness of the in-network providers suggested, and ultimately reduced costs to the insurer outside of their network. I fully expected another "no" from them and was prepared to file another appeal to our state's Department of Commerce (another right, by law). In fact I had already filed the appeal simultaneously with the appeal I filed with the insurance company. I didn't need the third, external review since my insurer found my arguments persuasive and they reversed their decision. The take home message in all of this is "don't give up" if you believe there is a strong case to be made. I think the insurers assume that most people won't go through the trouble of the appeals process. I can guarantee you it was well worth the effort in my case. (The total list price for my surgery, including very little pre-op diagnosis, the surgeon, anesthesia, radiology, labs, 3 of 7 in-patient days in the ICU, and one follow-up visit was nearly $120K not including the travel expenses). Lots of people were praying on my behalf not only for a positive outcome from the surgery, but also that our insurance company would come to its senses. Positive responses on both! I love it when a plan comes together.