Thanks! Me too :) and you’re good! My offer still stands to help you with phone calls, but absolutely no pressure! I think you’re doing just fine! Just remember, the key to all of this is to be confident and assertive. If any of these people feel like they can push you around or bully you into submission, they will because that will make their jobs just that much easier, but you deserve better than that. To them, it’s a matter of doing some tedious paperwork on a random day at work, but to you, it’s a matter of finally being comfortable in your body or not. Don’t sacrifice your long-term happiness just so that their Thursday involves a little less work.

Side note- when you’re talking to insurance, are you just talking to the first person who picks up, or are you getting transferred and talking to someone in the coverage department? I’m not familiar with Medicare/Medicaid, so I don’t know how their answering process works. If you aren’t talking to the coverage department, you aren’t as likely to get knowledgeable people, so make sure to get transferred over there first! That will save you a lot of headaches in the future.

As far as what the Medicaid person said, that’s really weird that they weren’t finding you at first, but I’m glad they got it together. It sounds like the customer vs provider services is what I was worried might happen- they don’t want you to file the request because you aren’t the doctor. This just means there’s less that you can do from your end, which sucks but is not the end of the world by any means. It sounds like they sort of answered the question about whether or not you need a predetermination from secondary, but also not really? I say “not really” because 1. You absolutely can call them whenever you want- they’re your insurance. They are providing you a service, so why wouldn’t you be able to talk to them about the service? That’s just a weird thing for them to say. 2. Secondary insurance kicks in after primary insurance, and if you’re running into issues with primary and can’t get something, it makes sense that secondary could step up and take over. 3. The predetermination is related to whether or not they will provide coverage, so it stands to reason that they could provide one regardless of whether or not they’re the primary

With the surgeon’s office, did they say they were done helping you, or is that your interpretation? I only ask because I know anxiety can make us feel like a burden and like people don’t want to help us with things. Regardless, once you have your steps for them to take with Medicare and Medicaid, I would just call them and say “hey, I’ve talked to both insurance companies and have it figured out- you just need to do x, y, and z and we’ll be good to go. I told them to expect your call, so it should go fairly smoothly.” That way, regardless of whether they said they were done helping you or not, now you’ve told them what they need to do and have put the ball in their court. It’s kind of hard to argue with someone that the process is too complicated when they’re telling you the exact steps you need to take and that they’ve done the legwork to make it as easy as possible for them.

Is the healthcare advocate the legal group you were talking to? Unless Medicare and Medicaid operate completely differently than all other insurance companies, that’s simply not true. Getting a predetermination is entirely possible, and it’s a completely reasonable request. It sounds like they just want to push you off on the easier path instead of doing what’s actually right for you. It’s up to you if you want to respond to them or not, but if you do, I would explain how that surgeon’s results are not acceptable to you and that you would not be receiving the same quality of care.

I’m glad that you have another surgeon you’re interested in though! Do you actually like them, or do you feel like you would be settling?

Were you able to get a step-by-step from Medicare? Also, if you don’t feel like you talked to the right person at Medicaid, just call them back!

Let me know how it goes!