An insurance story that isn't a disaster

Much as I despise my new HMO Obamacare policy, which I never, ever wanted, I have to admit they came through for me on cataract surgery this week, even though the surgeon, the facility, and the anesthesiologist were out of network: completely covered. I feel compelled in fairness to acknowledge this success. On the medical front, I dreaded yesterday's operation, but it turned out to be a complete piece of cake. By yesterday evening I already could see better in the new right eye than in the left, after relying almost exclusively on the left eye for some time now and sort of editing out input from the right. I have better distance vision without glasses in the new eye than I have with glasses in the left. I asked the doc to bias my new lens in favor of near vision; he believes that by this evening the swelling will abate and I'll be able to read without glasses, as I almost can already. Medical intervention is getting impressive in many ways.

11 comments:

Cassandra said...

Glad it went well. Taking my Mom in to have her other eyeball fixed tomorrow.

MikeD said...

I wish I had known you were dreading this. My dad couldn't stop raving about his cataract surgery. He said he too was nervous before, but he was so pleased that he's telling anyone who will sit still to not hesitate for a moment about it. While there's no one as devoted as a convert, I think there's more at play than that. He really was super happy at having done it.

Texan99 said...

Lots of people had told me that, but I couldn't make real to myself the idea that I wouldn't freak out when they tried to touch my eye. I knew it would be numb and everything, but the very idea was awful. It turned out to be nothing. My hindbrain didn't even understand that they were touching my eye; it was more like watching a movie on the ceiling full of incomprehensible images with no emotional import. And that was without any kind of zoning-out drugs, too. Amazing. The return of crisp vision is something else I knew intellectually to expect, but it doesn't change the startling reality. You sort of forget what clear vision is like after a while. I don't really think I should have been driving, particularly at night.

Grim said...

I haven't had the experience, but I do remember getting glasses as a teenager and being astonished that it was possible to see the leaves on trees at a distance.

Too many books!

Larry Harman said...

I'm so happy that this went so well for you, Tex. In every way. The insurance part was a relatively small thing, compared to the clarity of your vision, but I'm very glad that this came through for you, too.

Texan99 said...

They had offered me a decent cash price, so having it covered was nice but not essential. Also, it certainly would have been covered if I had gone to someone in the new network as of 1-1-2016. I trust this doc, though.

Grim, your experience is like my father's. He had awful vision as a child, never could read the blackboard in school. When he finally got glasses as a teenager he was shocked to learn that you could see individual leaves on trees.

E Hines said...

It's good that this went well for you. Being able to see well is truly wonderful.

My wife had lasik surgery several years ago on both her eyes simultaneously (lasik would not have done anything for cataracts), and I sweated bullets for the next 24 hours as she couldn't see--those post-op bandages/patches over her eyes. When they came off, though, she'd gone from 20:200+ to 20:20. Marvelous.

Eric Hines

Texan99 said...

The jury is still out on whether they succeeded in biasing the new vision toward reading distance. They're much more used to biasing it in favor of distance. They did a fabulous job, though. The surgeon makes a little slit up at the top of the cornea, like a shirt pocket, and pops a soft folded lens in there with a little device the size of a small pen, then gets it to unfold and lie in the right spot. There are no stitches. Really amazing.

douglas said...
This comment has been removed by the author.
douglas said...

Glad to hear it went well. My father went through it last year and it was equally as amazing and with wonderful results. I think his vision may be better than mine now.

The thing is, as government gets more involved in health care, there will be less incentive to innovate or take risks, and the sorts of developments that bring about procedures like this will diminish. Obamacare won't be so wonderful then as it is now while it's giving out things it didn't build.

Texan99 said...

Yes, one reason I dislike HMOs is the binary network/non-network approach. If they want to go cheap on coverage, I'd rather they covered a flat amount and let you pay the excess to go to a more advanced practitioner or one with a more sterling reputation, which would keep market forces better in play. I have no idea why they eventually decided to let me go to my excellent surgeon, but it's not a completely traditional HMO, more of a local professional network. I got a genuine feeling talking to its reps that they were focused on care, which I can tell you was a shock. They are persuading local docs to join their network who've never been willing to touch an HMO before, so I assume their reimbursement rates are not a total joke. And, though it's a shame to have to go through the nonsense of a referral by a primary care provider who's not even my real principal doctor, I have to admit that his office handled the referral process quickly and professionally. Also, the network PCP turns out to be a good doc with competent office staff who got all over the process on short notice; if they didn't happen to be 90 minutes away on South Padre Island and I didn't already have a perfectly lovely concierge doc, I wouldn't hesitate to see him as my regular doc.

I still don't trust the eye surgeons in the network. Maybe I'm being harsh, or listening too much to their professional rivals. I'll have to collect more information from friends and neighbors who've had their eyes done there.