Choristers

The person taking care of my house during this adventure sends me my mail once a week. I'd seen the packet from a couple weeks ago but put it aside knowing there was a bunch of stuff in it I actually wanted to look at.

Lo and behold: a notice dated 1/15 that the insurance company required more information from the surgeon before authorizing my hip replacement surgery. Note: said surgery was scheduled for the 23rd.

Also a note - the date of which I didn't notice - that declined the authorization for the replacement saying it wasn't medically necessary because it didn't meet several of the 9 or 10 criteria - ALL of which must be met to make it medically necessary - that were listed. And also that the hospital stay wasn't authorized because it could be done as outpatient or with a 23 hour stay as there were no comorbidities provided that would lead to the authorization of the stay.

Interestingly, there was *also* a note from the insurance company authorizing my stay at the rehab hospital for my non-medically necessary hip replacement.

Now first off: I *did* ask, repeatedly, if we'd gotten the pre-auth for the surgery and was assured we did not require one. Sounded very odd to me so I asked if we'd gotten the pre-auth for the hospital stay. Was told that's up to the nurse navigators (the ones I was not put in touch with until way too little time before the surgery). So I asked them if we'd gotten the pre-authorization for surgery and hospital stay.... which got the administrative nurse saying it was a good thing I asked because my surgery had been scheduled incorrectly and they were in the process of fixing it.

Secondly, I very specifically had expressed concern that the x-rays they took did not have a detailed report about the level of osteoarthritis, etc., as well as that my ADLs were radically affected by my hip issues (the notes said they were not affected, I wrote to them after the pre-op consult and said, "There's an error. Please fix." and they said, "There's no error."). Guess what two of the reasons for the declined authorization were?

Thirdly, if he proceeded with the surgery without getting the necessary pre-authorization AFTER I REPEATEDLY asked if the date had to move again because of a possible pre-auth issue (and after I reminded them that I DON'T LIVE HERE so, if it had to get delayed again, my stay here would be longer and cost lots of money) and I get a bill from the hospital? I'm sending it to his office SO fast and saying, "This one is on you; I raised a stack of flags ahead of time."

All that said, recovery seems to be going well. My rollator is too tall so I ordered one that has handles that can be set lower - but the one that arrived has a seat that doesn't lock down so it's unusable. Likely buying a new one before this one goes back. Which is unfortunate as I got it direct from the manufacture's "at home" site and it was priced way more affordably than from third party vendors... but I want it in hand so I can practice prior to the PT eval. Which was postponed because it was pouring and powerchair plus rain is no bueno. Thankfully, "tomorrow" (it's after midnight; it's technically today but I have not yet been to sleep and awakened again) it's going to be clear so I can get the sutures out and Friday it's going to be clear so I can get new labwork and see Dr. Hematology. Thank the Universe.

The next challenge is going to be getting PT to understand there is so much more to rehab than my hip, to figure out what physiatrist to see so I can get VERY long-overdue thoracic images taken, and then figure out what's next. Because, right now, research shows that it might take as long to recondition everything that has failed on my body (hip is probably 25 percent of the issues; no, Rehab people, it was NOT my hip that caused me to have issues with stairs!) as it did to decondition. Which means 7 or so years. Hip replacement is not the magic wand everyone said it would be. I knew that, even as I hoped otherwise. But unless my stamina comes back way faster than I think it will, and my ability to manage a rollator and so on over distance increases super significantly, powerchairs are not leaving my life any time soon. So yeah, that's another insurance hurdle.

To say nothing of the current reimbursement hurdles and so on. Fun times ahead. Onwards.

Well, I survived the hospital and then I went to the orthopedic floor of a rehabilitation hospital. It was a way shorter stay than I anticipated but it was "three hours" of PT or OT a day, except on your designated rest day. Three hours in quotes because, of course, there's stuff like just getting one's shoes on (because my aides weren't certified to assist me) and filling people in on history and more... but it was still a lot. So I arrived on a Wednesday night and it's a "soft landing", except of course it was a lot of people and they still didn't communicate everything I had to know, and then it was Thursday and Friday and Saturday was the off day - that one of the CNAs was going to come and help me shower, except they moved her somewhere else that day. SO frustrating; she was the only one I trusted to make sure the incisions stayed dry and so on. So that didn't happen. Then it was Sunday through Saturday, and Sunday again and they were discharging me on the 9th. Which I fought tooth and nail because, even in the short time that I'd been there I'd learned SO much.... and they were like, "this is supposed to be like a boot camp jump start" and I'm like "but you all are showing me how much ELSE is wrong with my body AND how to use it" and they're like buh bye. I have to admit it was fun to say to doctor and case manager, "Hey, I spoke to insurance and they said that, as long as I'm making progress, I can stay for a month as far as they are concerned." They looked at each other like, "Ugh, our main argument just got pulled out from under us."

The medical care there really kinda sucked. My designated doctor (a physiatrist) clearly didn't really want to know how I was doing; she was checking boxes. I refrained from saying to her, "You know, Doctor, calling your patient "dear" because you can't remember their name really isn't a good look." Then there was this internist who kept rounding on me even though he, technically, wasn't having anything to do with my care - but hey, it's another patient he can bill for.... and he nearly f'ed me up when he asked for 3 more iron infusions on top of the 5 I'd already agreed to with the hematologist. I thought I'd lost track of days when they did the sixth, and then I realized no that's more than I agreed to so I had them de-access the port.... then the next day the nurse said we have to access your port again, and I said why and she said because it's supposed to be 8 infusions. To which I said hell no I felt like pure unmitigated garbage this morning, and I wasn't consulted, and my anemia is not an iron deficiency anemia so no.

And then there was the hematologist. Who happened to be the hematologist I famously fired last Spring after I saw him following my discharge from my hospital stay because it was clear he was lazy as hell and wasn't going to advocate the way I needed him to in order to keep me safe for all my procedures.... and then stumbled into Dr. Hematology's practice - and he happens to be one of the most respected hematologists in the area. Which stood me in good stead with Dr. Fired (who warmly greeted me and I warmly greeted him back and neither of us talked about the fact that I'd fired him)... except of course Dr. Fired reminded me not to "break the system", saying that - in his office, or Dr. Hematology in his office, could do almost anything but here there was a way they did things.... and I definitely broke the system because Dr. Hematology had a note on my record to transfuse if I went under 10 (they don't do it unless you're at 7 or below) and I hit 8.4 and sent a note to him and Dr. Fired saying "PLEASE can we....because I'm trying to heal from major surgery here..." and then the internist (Dr. Slimy, for REASONS) was like "Oh the blood bank can deny it because you're now at 9.1" and making me feel like a princess for even asking. So yeah. The medical care there lacked something. A lot of somethings.

The food tasted better than the Big Hospital. Though it took them a while to finally figure out that it's a latex CONTACT allergy and avocados and more are not an issue, and that it's PISTACHIO, not tree nuts, and no, I do NOT have a gluten allergy. I was served one meal that was ONE three ounce piece of overcooked cod. No veggies. No sauce. Not even lemon juice. Plus two desserts, and a glass of cranberry juice. Took a picture of that one to show the dietician and she was like "Um that shouldn't have happened..." Initially the caloric intake was WAY too low. Noted that I'm supposed to eat 100 grams of protein a day and she wrote that I could get double protein for every meal - though it didn't always turn up that way.

But yeah, PT and OT showed me a) how deconditioned I am and b) how past injuries that were never looked at and/or never properly treated mean that replacing the hip gives me new mobility in the hip but I'm still super limited in so many other ways. That's really frustrating. Hoping to find a doctor I can talk some of this through with so that we can give me full mobility and not just the hip. Oh, and I learned my rollator is about three inches too tall for me. I've now ordered a new one that can be set lower. Here's hoping that improves my gait.

I have zero idea why I have to be off work for so long - though it is, ostensibly, going to be a bunch of PT and possibly OT. And I alternate between having zero interest in rushing back and thinking of all the notes I am SO behind on sending.

Damn the torpedos; full speed ahead?