9. Holding Pattern

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I haven’t posted in a few weeks about my weight loss journey because there hasn’t been much to say. I went to a support group meeting for bariatric patients, which counted toward my monthly diet class. I got my annual echocardiogram due to my heart condition, and I go back in a few weeks to meet with my cardiologist to discuss my results. At that time, I will get an EKG, checking off another box toward fulfilling my insurance requirements.

I also got the results of my lab work, which really showed no surprises. My TSH levels were high, indicating hypothyroidism, but I was expecting that. Prior to getting the bloodwork done, I had run out of my thyroid medication, and there was a delay in getting my prescription refilled. In the meantime, I was off the medication for 10 days, during which time I also got the bloodwork. As a result, I had a rough couple of weeks, feeling pretty crappy and having little energy. At the same time, my colitis flared up. It’s been a slow recovery, and so my exercise routine has stalled. I’ve mostly kept my eating habits under control, but the lack of exercise has meant no more progress. On the bright side, I’ve maintained the small amount of weight loss I had achieved. But I’m eager to get my energy back and feel well enough to exercise regularly again.

Here in the Midwest, fall has fully set in, which I mostly enjoy. But this time of year also contributes to lower energy levels and greater desire for comfort food. I’m trying to keep my spirits up, but mostly I just want to lie under a blanket and watch TV. I’m trying not to worry too much about how I’m going to stay active over the winter.

As I’m ticking off the boxes preparing for surgery, another concern has reared its ugly head: money. For the most part, I’ve ignored the financial aspect of the surgery, figuring I’d cross that bridge when I come to it. There’s no mention of money from the surgeon’s office during the whole process–they just manage the insurance requirements, leaving me crossing my fingers that everything will be covered. Realistically, though, I know I have a deductible to meet. So I checked my benefit, and I’ve met half of my deductible for the year: $2,500. And this is where it gets tricky.

Assuming the surgery is fully covered (and this is the nebulous thing about insurance–the consumer has no way to navigate the system), I have to assume I still have to meet my deductible before insurance will pay anything. So that means coming up with $2,500. Again, going on assumptions (because I don’t have access to enough information), once I hit my deductible, insurance will pay 80% of the cost, and I’ll pay 20%. Which leads us to the maximum out of pocket (MOOP). There’s another $2,500 to the MOOP, so I can assume my 20% of the cost will be at least $2,500, and $2,500 + $2,500 = $5,000.

So, I come up with $5,000 to pay for the surgery before the end of the year, or I do it after the first of the year, and my benefit starts all over–in which case, I will owe $7,500. Are you still following? I work in the health care industry, and this is about the depth of my knowledge.

Well, it is what it is. That’s what credit cards are for. I could probably even take out a loan at a lower interest rate than a credit card. But the thing that is really frustrating is that I won’t have any idea how much I actually owe until the insurance company says I’m approved for surgery. I have to check off all the boxes first, and then my paperwork will be submitted to the insurance company for approval.

Stay tuned.