BLAST FROM THE PAST: My eye is doing well; I sure hope they ...

From The News & Reporter, Sept. 2, 2009.  

You'd think, with the eyes of the world on not only the politicians involved but also the healthcare industry, because of this big emotional debate going on, an insurance company would be more careful.

Now understand, my insurance company is saying it's just a glitch. It will get fixed, they say. It's getting run through the process again, they say.

But there shouldn't be a glitch. It shouldn't have to be fixed. It was supposedly processed almost six months ago.

    I got a notice from my insurance company last week. It said a $2,800 charge from my eye doctor was denied. Said the policy only covered what was listed and to check the books on what was and wasn't listed. None of the books I've read with my insurance policy go into which specific procedures are or aren't listed. Just what will be paid at what percentage.

    I thought the eye doctor's had handled the pre-approval. They submitted everything, and when it was done, they told me how much I'd have to pay. Before the surgery.

    So it strikes me as a bit odd that I got a denial form, six months later, saying the “patient responsibility” for a $2,800 charge is $2,800.

    Having seen an earlier form indicating a bill for about $2,600 was paid, I thought perhaps a copy of some piece of paper went through the loop after falling off a paper clip. But when I called the eye doctor's business office on Monday, they said the $2,600 was for the surgery itself. There was an anesthesia charge from another office, not as much. There was a facilities charge from the out-patient eye clinic where they did the work.

    Then there was this final charge.

    This charge, basically, relates to the costs of getting me a cornea to transplant.

    Imagine needing a heart transplant, and the insurance will pay for hospital, surgeon and anesthesia, but you were told, “The cost of the heart's all on you.”

    I was a bit incredulous.

    My wife and I went into this knowing we could only do it if it was covered. When we were told what the costs would generally be, after the pre-approval, we thought we could handle it. 

    Of course, we didn't realize how long the recovery would take. I was out of work for a full month, and used up all my sick leave and vacation. My company has a nice thing where you get back a little of what you lost under its family medical leave act policy. But I had to use up all of my leave time first, and be out a little bit longer, before I qualified. It gave me a percentage of my regular, missed pay.

    At the same time, we had a week's furlough to contend with for me, which is lost wages. We have had since May a pay cut she got in her job. We will soon be contending with a week's furlough for my wife, as well.

    We're thankful to still have our jobs, given both the economy and the troubled industry we are both in. But we are also hurting. It's harder to make ends meet.

    So a $2,800 bill for the actual tissue that was placed on my eye had me a trifle concerned.

    Perhaps the guy on the other end of the line could detect a slight, hmm, something in my voice.

    “We can't pay it,” I told the insurance company guy. “Is someone going to repossess my eye?”

    He laughed, but it was a nervous laugh.

    He checked this and looked at that. I told him the billing person at the eye doctor's office said this procedure is covered under Medicare, and an insurance company almost always covers what Medicare covers. So I shouldn't worry, she said. She said they had just gotten the denial, and would put in an appeal.

    The guy accepted the info about Medicare, and did some more “this and that,” and said he would put it through again for payment.

    Just a glitch, he assured me.

    He did not assure me that the insurance would be paying the entire amount, however. Maybe it would. Maybe it would pay 80 percent, and I'd have to pay 20 percent. I can handle that, somehow.

    But since he did not guarantee it would actually be paid, maybe the insurance would still pay nothing.

    So I'm left wondering.

    By the way, I'm going to the eye doctor in a week or so. And the last time I went, I got 20/25 vision wearing my glasses.  So the eye is doing remarkably well.

    I sure hope they let me keep it.

BLAST FROM THE PAST: You might catch me staring ...

 From The News & Reporter, Dec. 24, 2008 

My left eye is going to be bloodshot on St. Patrick's Day.

I'm 100 percent Irish, but it won't be for obvious reasons. I'll be having eye surgery on March 16. I will have a cornea transplant and that's the soonest they can schedule it.

I've had a condition in both my eyes since I was probably 14 called keratoconus.

"Kerato" is a Latin for wart. The conous is the "cone" of my eye, the cornea.

The eye has several parts important to vision. Unbeknownst to me for the longest time, the part you would think does most of the focusing, the lens, inside the eye, actually does about 20 percent of the focusing.

I don't have a wart like one might get on his thumb, but there is a distortion of the tissue that covers the eye. You can't see it to look at it, because the tissue is very thin, and the tissue is also transparent.

But the tissue that bends the light to where it hits the lens is distorted. 

I've had it since I was in high school. We've tried a bunch of things. Contact lenses were once thought to help. I once had to wear a soft contact lens on one eye, over which they placed a hard contact. That was back when I was in college. It was annoying, and actually irritating.

Just recently, they suggested we try a new type of contact lens. It had a soft edge with a "semi-hard" center.

The contact lens in both instances was to take the place of my damaged cornea.

The piggyback didn't work too well that semester in college. The new-type lens didn't work at all most recently.

In my college years, at two separate times, I had surgery then. Long name for the procedure, but it was a graft. They put a little bit of someone else's cornea on top of mine. It was intended to stabilize my vision. It did well enough. I still needed glasses to see good, but my eye worked well enough.

I continued to see the doctor who did my surgery up until a few years ago. He doesn't do this anymore, I understand. He passed me off to another doctor in his practice. It's actually a family operation, and I have a lot of trust for what was done. I had two procedures done on my eyes then. You see, you only do one at a time.

Anyway, my former doctor said that he was amazed how long the grafts had held up, but they were beginning to go.

The vision in my left eye is atrocious, and the plan, right now, is to do that eye. But my right eye is actually a bit more fragile, despite giving me substantially better vision. And I wonder if I'm making the right choice.

I'm not much of a daredevil, but I'd almost like to do them both at once.

I'm amazed at how the technology has come in certain respects. For other problems of the eyey, cataracts, etc., they can use a laser to reshape the eye. But not this.

I don't hear much about the graft being done, though I've fallen off the National Keratoconus Foundation's mailing list since it merged with another eye disease group.

But this procedure that was done at a hospital when i was 19 will now be done on an outpatient basis at my doctor's office.

There will be pain. But I remember what happened the last time. I had it done over the summer, so it didn't interfere with college courses, not that much. The vision problem did interfere with it.

I've had my prescription changed about four times in the past year, and we didn't get one the last time I went in. Thought it could perhaps survive.

I'm sure it's hard to do any job if you can't read. But reading is about 90 percent of my job. There's this solid waste plan for Chester County that I've been dying to delve into, sitting on my desk.

My right eye is fragile, I think, because it's been carrying the load for so long. So after the shock to my left from the surgery subsides, it will take some time for the vision to settle in to what it will be. I'll have stitches in my eye for almost a year, though some will come out sooner, and some will "pop" too early and cause something between an itch and pain like a molecular sized needle stock in your eye.

When they told me what day I was going to have surgery, I had the opening line of my column right away. 

I thought it was funny, and it had the added benefit of outraging one of my sisters and my mother.

"How can you make a joke about this?" they wanted to know.

It's the easiest thing in the world to make fun of it. If you can't, then it owns you.

It's an established procedure. I think this doctor is about my age. I might be a little weirded out if he were younger, but that will have to happen someday, right?

And while there's some humor to be made at the situation, and it will certainly get funnier as the day approaches and they ask you all those silly questions, we have to take it seriously.

I've never really had good vision in my life, but if something does go wrong, what I have today might be the best vision I'll ever remember as an adult. There's a lot to lock in. My gorgeous bride, my smiling, blue-eyed son are foremost among the things I will have to memorize.

So you might catch me staring.

PS: I wrote the following short, short column a few days before my 2009 surgery, right before I took what was supposed to be a week off and turned into a month off.

’tis no time for Irish jokes, me ma says

Originally published in The News & Reporter, March 11, 2009 

I’ve written about my eye problems before and written about my upcoming surgery in a column when it was scheduled. I joked about it, because of the timing.

I’ll be having it Monday, March 16. St. Patrick’s Day “Eve,” so I wrote I’d have a bloodshot left eye on St. Patrick’s Day, but not for obvious reasons. That made my mother and sisters a bit angry.

Normally around St. Patrick’s Day, I try to regale my readers with Irish jokes or tell them at length about Irish music and songs and writing.

But we are a pretty busy bunch of folk here at The News & Reporter these days. So I have to appease my sisters and mother and we have to do “important” work.

A good newspaper does have a sense of humor, but times are tight on space these days.

The N&R will be closed on Monday. Please get your items to our staff for next Wednesday’s paper as early as you can. I’ll be out for a week. If you need to get a news story in, please call Travis Jenkins or Nancy Parsons Tuesday through Friday.

Thanks for your well wishes. and I promise to treat my new cornea better than the old. No more using it to hammer nails into the wall.

Sorry. Forgive. Please allow me a little bit of humor in my last column before I go under the knife.