Right on time.

God is always on time.

We reported to Loma Linda at 7am on Tuesday morning without insurance approval.
We got all checked in; Josiah got in his gown; Nurses took his vitals; Anesthesia came by to consult with us; Dr. Nelson stopped by to say hello.

At 8:45am, I heard a nurse on the phone mention Navarro, and "Oh, well, they're all set to go back in a few minutes. (Pause). Oh. Ok. I'll let her know."
I was waiting for her to come over and tell me that we did not have authorization to go through with the procedure...
but she didn't!
I took some last TSF pictures...

Look at his SUPER LONG toe nail! Gross! Lol. I asked the doctors to PLEASE trim them. I even signed a hand-written consent for it! :)

Then at around 9am, Josiah was given some pre-op "silly medicine" before the anesthesia team came to take him back.
They later told me Jo informed them all that he was going to be Batman for Halloween, that his sister Ava was 2, and that his brother Jack was "this big" (showing about an inch between forefinger & thumb) :)
Every surgery they've told me that he has been very calm and brave.
(Peace of God!)

Surgery started at 9:30.
He was out by 10:30.
While we were waiting, we went downstairs to the cafeteria. While there, I got a voicemail (there's no signal upstairs). I listened to it and it was Kim, the surgery scheduler. She said that a little after 8:30am, "they received the approval directly from Health Net. Everything was good to go."
Amazing.
Though it was a big headache on Monday, I am thankful for Anna (from Health Net) and Tammi (from Loma Linda) for working diligently to get it resolved in time. (I still have to figure out my Primary Care situation, and make sure we will be able to go back to Dr. Nelson in the future, but for that day, it was all good).

After surgery, Dr. Nelson informed us that everything went great.
He casted the foot in the hyper-corrected position (stretched to the left) for good measure, and said Josiah should be able to walk around on it soon. (Can't wait!) He also told me he had already enjoyed a post-op cupcake. :D (We had brought the surgerical team cupcakes (from My Delight Cupcakery, of course).

We're due to go back on Monday morning for them to remove the cast, check the pin sites, and recast him. I'm leery of having them take it off and recast him when he might be sore still. But then again, it'd be nice to check on those pin sites.

Jo did have pain when he woke up and he was pretty grouchy. He kept asking me, angrily, why God allows pain. (Another one of those teachable moments this frame has provided. I told him, "God does not promise to keep us from difficult things, but he does promise to be there with us. He strengthens us, and comforts us. He's also teaching you about compassion through all you're going through").
But by the time we were ready to go, he was doing ok.
We left Loma Linda at 1:30.






Here is Josiah today (Thursday) with the new Lego creation he just built. (Thanks Nana!)
He has not needed any pain medication since last night when we gave him Tylenol and Advil.
Praise the Lord!

I must say, I'm in love with his new cast. It's so little! :)
He'll have it on for 6 weeks.

We are all so excited to be done with the frame!
As you can see, we've been counting down the days.
106 down, 41 to go!


We're looking at the week of Nov. 13th for cast removal.
Guess we'll need some new Thanksgiving Shoes!

We have a lot to be thankful for.

One of the people on the top of our list this year will be Dr. Nelson and his team.

Thankful we have insurance... BUT

I am SO thankful we have insurance because without it, there's no way we could have done ANYTHING with Josiah's clubfeet. From castings, to surgeries, to custom orthotics, to the TSF, all of it would have been beyond our financial means without insurance.
BUT...
What.A.Pain HMOs can be!
If you don't have an HMO, how it works is this:
You have a Primary Care Provider (PCP). This is a family doctor who you is your first stop when anything is wrong. He will treat you. If he can not, or if it becomes a "specialist's issue," then the PCP write a referral; however, before you can just make an appointment with the specialist, the insurance must first give you authorization. This takes 1 to 3 weeks. Once authorization is established and sent to the specialist, they usually call YOU to make an appointment. (It's always good to call them after a week or two to see if they've received the authorization. (Don't trust the paper work system!) Occasionally, the specialist the PCP has referred you to is not someone the Insurance wants you to see. They have preferred doctors they want you to see. Of course, sometimes they just see what's on paper, and they send you to someone who is not what you need. (This happened to me with Josiah-- sent me to an orthopedist who doesn't deal with children... and it happened with Jackson-- sent me to an audiologist who doesn't test infant's hearing). Errrrr.
Anywho, in this particular case, we were authorized to see Dr. Nelson at Loma Linda. It turned out to be a God-send.
Of course, you know the rest... Josiah had the TSF put on in June, and we've been stretching & correcting it for 100+days now.
Surgery was set for Tuesday... just 3 nights away!

BUT THEN...

We got a letter last week. Our HMO plan renews each Oct. 1st. Usually this is uneventful.
However, John's company tried to save some money and changed us from the regular HMO to "HMO Silver Network." Apparently the Silver Network further restricts the doctors we can see.
We were told that we were reassigned to a new PCP, a doctor in FOUNTAIN VALLEY! I don't even know where that is, but it's not nearby.
So besides not wanting to lose Dr. Craig, the PCP we've had since I was pregnant with Josiah, the bigger issue was that our current authorization through Dr. Craig is the one we were going into surgery with.
Now that we've been "reassigned," we need a new referral from our current PCP to an orthopedist... this new "Silver Network" may not have Dr. Nelson/Loma Linda in its "network."
And even if they did, who knows how long it would take to #1 find a new PCP (because we're not going to Fountain Valley!) #2. Establish "care" with an appointment, #3. Request the referral to Dr. Nelson, #4. Wait for authorization #5. Make a new appointment with Dr. Nelson for surgery.

I was on the phone for over an hour on Friday with Health Net trying to get this all straightened out. The good news is that Dr. Craig (our current PCP) is in the Silver Network. If they would have just "reassigned" us back to him, there'd be no problem... but apparently it's not that simple. That medical group is "at capacity" and not accepting new patients. I tried to explain, I'm NOT a new patient. We've been there 6+ years. The guy tried to call the supervisor to see if she'd override the system and reassign us. She said she couldn't. We can appeal it, but it takes 7-10 business days.
So I said, Ok, then what else can we do? He has to have surgery with THIS doctor on Tuesday. This TSF is not something just any surgeon can deal with! We NEED to get this thing off asap.

The best they could do was submit a "transitional care" request which I think will allow us to finish whatever was already authorized. It will take 1 business day to find out, which is Monday. I'm not sure if it will be enough time to get Loma Linda satisfied that we're authorized for a Tuesday surgery. I'm FERVENTLY praying that it can be squared away on Monday morning.

Sure, after 100+ days of this, you'd think another few days, even another week or two wouldn't be the end of the world... but for this 6 year old little boy who has been counting down the days to normalcy, it would be close to the end of the world. And for this weary mama, I would have to agree.

We'll deal with what comes, but we're praying that things go our way tomorrow.