Upcoming MMA - Winning Strategy
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Upcoming MMA - Winning Strategy

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Posted by jimplasticguy on March 02, 2011 at 11:30:28:

Hello everyone. Thanks for your posting of experience over the years. It has greatly helped me with decision making the last few months. I still have a nagging issue.

Quick background is that I have suffered from severe apnea for years, well documented. In About 5 years ago, doctors were unable to successfully titrate me, and recommended surgery within 3 days. I had the UPPP, deviated septum, and turbinate work. The years since then have been a nightmare of wildly changing prescriptions on CPAP, etc. Many know what I am talking about. I have been 100 percent compliant for over 3 year, am on medications to keep me awake, and am now at over 30 AHI on the Bipap at high pressure and auto. This thing is destroying me.

With the help of your forum and blogs, I made a decision to go out to Palo Alto for an assessment, and now have scheduled my MMA surgery for two weeks from now. I am a detail guy, and I am trying to optimize my chances of least out of pocket with the insurance company, which starts with a C, is a PPO, and is known to be one of the best for this.

I have searched the board like crazy, as well as every blog that I could find, and a few of you that I have tracked down have been kind enough to trade emails with me. What I need to go for is called a "gap exclusion." The insurance company has approved the surgery (out of network) and has told me this morning that if there is no in-network doctor within 25 miles, it will be paid as in network for the surgeon fees. The hospital is already in-network.
They offered me 3 surgeons, but I protested that they should be board certified. They came up with only one. So I thought I had this thing licked, and I may, because I don't believe he will have the qualifications. I called the office today and the front desk had a heck of a time pronoucing the surgery. She finally goes and talks with the doctor, comes back, and says "Oh yeah, he can do that. Schedule an appointment." There is probably a very good chance that he doesn't feel like consulting over the phone and will at least make his fee for the office consult. So, I am supposed to see him next week. I will gather all my information, but I may try to make one more call, even offer to pay for a phone consult, so that I do not waste my time with so many other things to prepare. I will proceed with my surgery as planned, because based on my research, I have the best surgeon. This is a financial excersise, one that could save me the cost of a car.

I believe I need to do the following:
- Gather paperwork from Palo Alto
- Consult with this in-network physician and ask a list of questions if he doesn't admit defeat right away.
- How many of this specific surgery, at more than 10mm, have you performed.

... And more questions. Can you all help me with a good strategy on questions, and any other thing I might be able to do? Only one in-network choice seems like a potential argument. I am trying to do this legwork beforehand, and have the insurance company agree, if at all possible.
Thanks.

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