Surgury Prep - Insurance is crazy

[Erwitchin]

I am getting ready for my AVR on June 12. (Bicuspid valve, velocity >4.5 m/s). I have decided on the mechanical valve (I am 51 and I just can't justify to myself planning another AVR in 10 ish years)
I am feeling ok about it, but insurance is crazy here in the US. I am lucky enough to have coverage, but I just got my letter of authorization for my surgery.
BCBS of Louisiana seems to think that 2 days of hospitalization after open-heart surgery is all I will need. I mean, that would be great, but seems psychotically optimistic. I contacted my surgical team. We had a laugh and they filed paperwork estimating 3-5 days, which is the norm for a mini-thoracotomy. I can't believe that we can't agree that this system is nonsensical and that we need to remove the middle man insurance companies (and therefore half the expense) and move to a single-payer system like most of the civilized world.

 

[pellicle]

Hi

and firstly wishing you a straightforward surgery and an uneventful recovery.

BCBS of Louisiana seems to think that 2 days of hospitalization after open-heart surgery is all I will need. I mean, that would be great, but seems psychotically optimistic.

I suspect some bean counter counting beans with a bonus based on how much they save.

In defence of that if it was 2 days after ICU that might be more like it. There is always the slant that "the longer you're in there the higher the risk of nosocomial infections.

I contacted my surgical team. We had a laugh and they filed paperwork estimating 3-5 days, which is the norm for a mini-thoracotomy.

IIRC I was about to be released on day 5 (standard OHS), but was held back due to an infection of the wound. We know where that eventually went...

Best Wishes

 

[Lisa from LJ]

Do you mean they authorized two days? If so, the expectation is that a case management nurse will call and give them clinicals at the two day mark and they'll no doubt approve more days. It's their way of making sure you aren't in the hospital longer than needed, which is a good thing both financially and clinically. For our transplant patients, they usually authorize 4 days at a time.

 

[Erwitchin]

Do you mean they authorized two days? If so, the expectation is that a case management nurse will call and give them clinicals at the two day mark and they'll no doubt approve more days. It's their way of making sure you aren't in the hospital longer than needed, which is a good thing both financially and clinically. For our transplant patients, they usually authorize 4 days at a time.

Yes, but it says that extensions must be filed prior to the date of stay, which makes no sense. How would they know in advance?
The surgeon estimates 3-5 days, so I would think the insurance would authorize at least 3 to start. (And here I thought 1 day for childbirth was pushing people out early).
The clinic already filed the extension paperwork. It will all work out. I just find it insane.

 

[Protimenow]

They can't release you until you're ready to be discharged -- their liability would be way too high. I think 'two days' may be standard, but if they have to extend it, I can't imagine them putting your life at risk by forcing a release when you're not ready for it.

This could be paperwork B.S. - and maybe it's the way they always handle these things - with the knowledge that they'll have to extend it,

Good luck