Dr. Glazer / Insurance / Young Children

[Guest guest]

I have decided to move forward with having revision surgery done soon -- with Dr. Glazer.I've been reading through my insurance paperwork, because I wanted to see how much money I might be on the line for as a result of the surgery/follow up visits/x-rays/PT/etc. I noticed a clause in the benefits handbook that says they will review my records to determine whether the surgery is a " medical necessity, " and if they deem it not to be, they will not pay for the surgery. I didn't know insurance could do that! I've never had trouble getting things covered by this insurance in the past, but then again I've never had surgery while on this insurance plan (office visits, injections, medications, PT, aquatic therapy, TENS unit, x-rays, bloodwork, prenatal care and birth -- all covered by my insurance with no complaints). How often does an insurance company exercise this option and actually deem something not to be a " medical necessity " ? In my case, I'm dealing with Harvard Pilgrim.

I'm still trying to figure out how the logistics will work, considering the fact that I'm a mom with a three year old (who will be almost four years old by the time I actually have the surgery, I'm sure). She understands that mommy's back hurts, and I always asks her to be gentile, but she forgets very quickly. How do I make sure she really understands and is always gentile with me? Our current situation isn't great anyway, since I'm constantly having to say, " Sorry, you know mommy is not able to do that. " She keeps asking me, " Mommy, when is your back going to feel better? " It breaks my heart. Any advice from those of you who went through it while you had small children at home?

I apologize for multiple topics in one email, but I figured this was better than flooding your inboxes. Curranmelissacurran530@...

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