We had an issue with Amanda’s main rejection medication night dose. They had the wrong dosage, and someone never updated the new dosage. It is an ever-changing dose dependent on the levels in her blood but has remained the same for a while until the infection. They took her off another rejection medication and wanted the level of this one slightly higher. These medications are time-sensitive and need to be taken every 12 hours. I gave her the morning dose. We didn’t even ask the nurse in preop, and it’s not worth a fight and all the approval.
Amanda doesn’t mess around with that medication; she always takes it and has backups wherever she goes. I think in nearly 4 years, she’s only missed one dose. So, it took a couple of hours to get the new dose from the pharmacy, with the nurse having to call the doctor. Little did she know I had an alarm set to give to Amanda regarding what the doctor or pharmacy said. After the last knee surgery issues where they just wouldn’t give it to her, and I had to. So, I was locked and loaded for an issue this time!
The room we are in is big, and this is a newer hospital. I can tell by the size of the rooms. There is a fold-down sofa bed that is hideously hard! I’ve never seen one like it. The back of the sofa folds down on top of the seat. So you sleep on the back of the back, and it’s about as comfortable as that sounds. I did manage to get a little sleep in; I’m a hard sleeper. Not much wakes me. I had to ask Amanda if they helped her to the bathroom or not because I knew I wouldn’t have woken up.
I think Amanda is doing much better this round already. Her overnight pain was much less and better controlled. The hospital and doctor protocols are all different this go around. They already had her up, dressed, and in a chair this morning before 6. Neither of us gets up early, and Amanda is far from a morning person. I think the protocols have helped her do better thus far. Also, the surgery was partly quad-sparing. Last time, the quad muscle was mostly cut into, but this time, it was mostly left intact, which should help with a quicker recovery.
She’s still in pain and needs pain meds frequently, but she is much better than I was expecting. She tried alternating one of the lower-level meds, but it didn’t touch the pain. Either way, we made it through the night with only oral meds, so the chance of going home today is good.
This hardware is completely different from the last and made for a revision. It puts more tension on the ligaments but sacrifices and puts most of the weight on the hardware, thus making it wear out sooner. She’ll only get half the life of the other type but more stability, so it’s a give-and-take. Also, stairs will be a nemesis, the doctor said, not pain, but she would likely never feel comfortable using them. I asked about unleveled ground and hiking. He said that usually isn’t a problem; just the stepping up and motion of climbing stairs will be different with this type of replacement. Upon replacing the worn hardware, it will be just a hardware replacement and not bone sawing, more give and take. I think longevity will be dependent on her activity and should last a while with her smaller frame.
Since we’re up early, Amanda is napping, and I feel like typing, let’s talk about the maximum out-of-pocket drama! So, the insurance has a cap on this, but it’s not as it sounds. Even once this limit is met, which doesn’t include the deductible or copays, we still have to pay the copays. I would prefer the term maximum co-insurance. This is a gripe, and I know we have great insurance. I’m sure it’s considered a Cadillac plan, but we used to pay nothing when I hired out with the railroad over 20 years ago. And I mean nothing, 100 percent coverage for everything, no copays, no co-insurance and no premium, so I’m coming from that angle. If what we have now is a Cadillac, the old plan was a Bently!
We usually meet our maximum “out-of-pocket” before May each year. Sometimes by February or March! It’s no different this year after the Houston stay bill hit the insurance. Prior to this, last week, the surgeon’s office was calling for their portion; they wanted to collect the co-insurance portion, which was limited by the out-of-pocket. It was close to a grand left, but the hospital stay still hadn’t hit the insurance just yet. I was prepping Amanda on what to tell them. She is a pacifist and would just pay them without question. I’m a little belligerent when it comes to this type of thing, so I was ready for a fight!
They called while Amanda was at the neurologist’s office, so she handed me the phone. It was my time to shine, and I was ready to die on this out-of-pocket hill! I explained that we had a $40k hospital stay that would soon hit the insurance and wipe the out-of-pocket limit. I told her I could send a receipt. I was prepared and already had Amanda retrieve one.
It seemed I would meet my match with this billing clerk; we argued back and forth. I told her this wasn’t my first rodeo, and she informed me of her years in the industry. She wanted to try and comfort me, saying they would refund us. Not being my first rodeo, I knew that was a tale. Amanda said she could tell it was going well when she saw my body language through the window. Neither of us would budge; I ended the conversation with I’m not paying a dime until the day before surgery!
We hit the maximum out-of-pocket on Friday, so I was ready to gloat when they called on Monday to get the payment. I didn’t take the call, knowing better. It was the same lady trying to collect the previous amount due. Amanda explained that the hospital stay had, in fact, cleared. The lady was ready for a fight and told Amanda she waited per her conversation with me, also saying she had checked that morning and we still owed. Amanda told her she was looking at the balance, and it was maxed out; huffy, the lady said what are you looking at? Amanda told her our insurance app and asked if she, in fact, checked the balances that morning, which she obviously didn’t.
I was getting ready and was so mad listening to the conversation that I was shaking while putting on my jewelry. It’s a good thing Amanda handled the call! The lady finally checked the balances, putting Amanda on hold. Once she came back, her tone was completely different, knowing we were right and didn’t owe a thing. If we had paid, we’d have been out a grand and still owed the hospital the same amount since their claim was first. Just like I said, it was not my first rodeo.