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.