When Life Gives You Lemons

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According to all the research, there is only one definitive treatment for lipedema: lymph-sparing excision through surgery which actually removes the affected tissue. This surgery has been performed in Germany for over 20 years and is their standard of care. As I mentioned in my last post, the surgeon in Atlanta has confirmed that Amy needs these surgeries, and the cost is $24,000 ($8,000 each procedure).

So we submitted a claim to our insurance company with all the accompanying paperwork, and this was their response:

“Based on the current plan and the clear-cut denial for this procedure, we cannot provide coverage at this time. However, based on the information Rick provided and other information that I’ve gleaned, we will be bringing this to the Benefits Committee in August (no patient name) asking for an exception for this service and proposing a plan change to accommodate this procedure when it’s medically indicated. I am also sending the medical records to our independent review company to obtain an opinion on the procedures listed with an assumed absence of our plan’s exclusion.

Okay, I’ll be honest. I feel like life gave us lemons today and I’m not sure how to make lemonade out of this so I’m not going to pretend like I can. I’m just flat out frustrated and disappointed. It all seems so simple:

  1. Amy has a disease that causes chronic pain but there is a surgery that can eliminate the pain and we have health insurance!

  2. Oh wait. They won’t pay for the surgery she needs.

My response is two-fold:

  1. Pray. We pray in all circumstances. Sometimes we have good days. Other days are like today. My pisteuo isn’t in the health insurance company anyway–it’s in Jesus. So He’s the One I’m going to talk to.

  2. Care for my wife. We are moving forward with Amy’s first surgery, scheduled for 7:30am July 7, 2015 in Roswell, Georgia. I put the $8,000 fee on my credit card and am praying for the Lord to help cover the bill, through insurance or otherwise. The other two surgeries are on hold for the time-being.

Friends, thank you for your continued prayers for Amy’s healing!

Rick Mumford