The Case for the Brace

So Jen from Cigna helped the case for the brace move up to Tina from Cigna who will bring it up to Dawn and after Dawn it’s just Amtrak left to work on…. This sounds confounding but it is progress!

The reason at the moment for all this is that the code for the brace ends in 999. 999 means miscellaneous and any 999 code over $500 must go through higher levels for approval and have additional supporting documentation.

It does seem fairly reasonable to want documentation before shelling out overĀ $10,000. I did point out to Tina that this is way less than the cost of another surgery. $10,000 would not even likely cover one day’s hospital stay post op.

In the mean time while we wait for approval Nick and I are going to Hanger! We fly into Seattle on Sunday, visit Hanger Monday and Tuesday and fly home after midnight. This trip is just for Nick to get fitted. This is the first step and we will have to fly back and stay for a week when the brace is created but this gives insurance more time to authorize it and Nick is just dying to get moving on this.

We are blessed beyond measure to be welcomed by a friend in Seattle. Remember how I wrote that Jen’s are awesome… Well of course her name is Jen! I have only met her in person one time but she is one of the kindest souls and I really can’t express how grateful I feel. It reminds me that we have support and things work out.

This is happening.

What if…

A conversation on the Facebook support group, regarding choice of surgeon and limits of insurance, had me thinking about when we first went to the RIAO. Nicks first orthopedic doc at NYU, Dr. Al Grant, suggested we see what Dr. Paley had to say. Its the only name he offered for a second opinion. He said every other doctor he knew would recommend amputation. Dr. Grant was in the middle regarding amputation versus lengthening and he warned us that Dr. Paley was “a bit of a cowboy”.

The night before our appointment in Baltimore Dr. Grant called to tell us he believed lengthening was the right choice for Nick. We realize he had just been at a conference with Dr. Paley and made his decision based on Paley’s information and experience. We counted that against Dr. Grant. He had said he could do the surgeries and could hold our hand through the whole process. He was really interested in treating Nick and I think he was being honest. Since he didn’t have as many lengthening patients. I think he realized that sending us to the RIAO for a second opinion meant there was a good chance we wouldn’t be coming back.

We met Dr. Standard at Nicks first RIAO visit. He spent a lot of time with us and we liked him right from the start. However we were there for Dr. Paley. He had been on Oprah for goodness sake! Anyone who knows me, knows I love Oprah (haha). By the time Paley left the RIAO a few years later, Nick was beyond established as Dr. Standards patient. That happened at the start due to his availability but in the end I am sure, was just as it was meant to be.

I have tried to consider what we would have done if the RIAO didn’t accept our insurance. I think at first we would have tried to get insurance that would have worked. As it was I avoided thinking about the money and didn’t research much about the cost of surgery. I just figured we would do it and deal with the consequences later. We ended up selling our home in Brooklyn and buying a much cheaper home in central pa, paying for a cobra plan and taking a year off work to care for Nick. Selling the house enabled us to do that and I know we were super lucky. In fact I felt like it was fate that we had bought my grandmothers house and then sold it to pay for Nicks care. I loved that tiny old house and the neighborhood it was in. I don’t know that I was totally honest when telling people why we were selling and moving but the truth is it was all for Nick.

The day before Nicks surgery we got word it was being canceled because we didn’t have insurance. I think because we changed to the cobra plan something was off. Once they realized that we had the cobra plan it was on but it was a few moments of crazy stress.

So in the end I haven’t answered my question as to what I would have done. Dr. Grant certainly knew FH. He was basing his, in the middle opinion, on the old adage of 3 toes lengthen, 2 or less amputate, which was already outdated by then according to the RIAO. I understand the logic. You need a certain amount of foot for the foot to be worth saving. The toes just aren’t the bones that determine success.

If we had chosen Dr. Grant we would certainly had not left NY. Fibular hemimelia put our lives on such a different course. I believed I was making the best decisions I could for Nick. It’s hard to imagine things any other way but back then it was us and Nick. Now with 3 more kids I think they would have factored in the decision too, had they been around. It would have been harder to pick up and move. Surgery complicates life so very much. Right now it’s all they know and I don’t think they’ve ever felt put aside for the sake of Nicks leg. I hope it stays that way.

In the end it’s not really possible to know what the right thing for another family is. Asking what if regarding our own past isn’t really relatable. My advice is usually to become as well educated on options as possible and then follow your instincts. Becoming well educated on options goes beyond just amputation versus lengthening.

Ten years later I can’t answer the “what if”. I can only be grateful to be where we are. Nick has a basketball game after school today. He wasn’t feeling great this morning but when I told him he had a game today he said, “My team needs me”, and got on with getting ready.