Bear with me, that title is going to make sense in a few paragraphs.
On December 16th, 2024, I met with an orthopedic spine surgeon to discuss my MRI findings and a proposed surgery. He felt that waiting any longer than necessary to do the surgery increased my risk of permanent deficits, specifically he mentioned needing a cane or a walker if we waited more than a few weeks. An EMG just two days later showed some damage to my motor planning nerves. That same day, surgery was scheduled for December 24th, and when my surgeon spoke with me the morning of the procedure, he told me that there was a possibility I wouldn’t see any improvement for my current symptoms, but that what they were planning was that this surgery could keep things from getting any worse.
Me, from a screenshot of an I love you video I sent my kiddos after the surgery, and with an allergic reaction to the adhesive on the waterproof dressing they were used as shown on Dec. 26th from a picture sent to the surgeon.
For a few days now I’ve been walking ten thousand steps a day or more. Yesterday I was over 13K. I might have been there sooner, but I ended up with COVID less than a week after my surgery, which pushed my sitting heart rates into the 150s initially, down to 125 laying down in the ED. The ER doctor put me on Paxlovid, and thankfully I didn’t have any sort of allergic reaction and it helped bring my heart rate down quite a bit (I wasn’t so lucky as regards to the sennosides they used in the hospital after my surgery, but it was just hives and redness for that so not so bad either). While my sitting heart rate is thankfully much lower now, it’s still not quite what it was because COVID can’t seem to touch my life without igniting a POTS flare up.
Overall, I am recovering well and each and every day gets better. Most of my previous neurological symptoms are gone, and the remaining have been improving bit by bit. I’m playing piano with fewer mistakes than I was in the last few months before the surgery, my handwriting has gotten better again, and it’s no longer so difficult for me to type. So, you’d think that would be cause for celebration and it is. But every now and then it seems like there must be a fly in every ointment, and so here it is:
A new year, a new insurance plan through my husband’s employer.
UMR.
In case you’re not familiar with that name, it’s a United Healthcare company. I have no doubt at this point because of the news you’re vaguely familiar with who they are even if you’ve never had the insurance yourself.
They’ve already denied coverage for the bone growth simulator ordered by my surgeon. I had a cervical corpectomy with the vertebrae portion they removed being cut up and put in a titanium cage they used to stabilize the area that had to be cut out to remove the disk pressing on my spinal cord, so he wants to prevent non-union or lack of fusion for those pieces. Definitely a medically reasonable request under the circumstances.
And this morning it was confirmed to me that Tony’s OT and PT services would be put on hold until further notice because the agency who has been providing those services for years (Amara has been working with us for I think close to 7 years now, and we were with that company for different therapists before her) won’t accept patients who have that insurance any longer unless it can be proven that UMR will pay the claim. What I was told is that they’ve been stuck in a cycle where they call UMR to see if prior auth is required, they get told it’s not, then they submit a claim, and the claim gets denied for lack of authorization…but not in a timely manner. UMR isn’t returning those denials within the time frame required by DDD to get reimbursement if the claim is denied.
So they had to eat those costs. And they need to be able to pay their therapists. Also a very reasonable expectation. I called the prior auth line for our insurance today because it’s handled by a different company for PT/OT (and that company does have reps working today). I was told no prior auth was required by the person I spoke with, Ms. S. The therapy provider called UMR last week and was told that they showed that authorization will be required for our plan (something the prior auth company denies). The prior auth team said that they can’t do anything about that and to take it up with UMR. I called UMR, and sat on hold for more than 30 minutes before an auto recorded message finally came on saying they “are currently closed to observe the holiday, please call back…”
And just like that, UMR happened to more than one of my days in the past week. UMR happened to my son’s life in a way that is harmful to him. If UMR pays or processes one of his January claims in a timely manner, this therapy provider may resume his services. If it is handled by UMR the way other cases were handled for clients of this provider, they are going to terminate his services immediately through their company, and this is one of the bigger in-home therapy providers in the area. Depending on how long UMR takes to go through this process, Tony may even loose his current therapists and have to wait for new ones to be assigned even if they do pay, and that’s been very upsetting for him. I have heard from this provider that taking more than one month was common for the denial process to play out for claims for other clients with UMR in recent years.
Indeed.
It’s a good think I’m recovering so well from this surgery. While I’m hoping for good things to come out of this, I recognize we may need the strength of my current recovery for more than just the return to me doing therapy work (Tony and I already did hab today) or my return to working in the school with Tony tomorrow. I wish each of you wonderful week ahead. Much love, Ari
