Tuesday, September 13, 2011

Seeing on the Other Side

Such an Interesting Time!  Early in the year, I noticed that my 6-month-old glasses weren't working.  Everything was blurry out of my left eye.  I went to my optometrist.  He tweaked and tried and couldn't get a correction that worked.  At one point I asked why I was seeing the letters doubled.  He got real quiet and went out to get his father, an optometrist with many more years experience.  Of course, the worry was that I 1) had a brain tumor, 2) was having a stroke, or 3) something else.  The older optometrist was able to get a prescription that worked, but it was a worrying thing.  Within less than six months, my vision was blurry again.  For other reasons, I thought I might be having a detached retina issue in that eye.  (My first detached retina was 20-plus years earlier in the other eye.)  This time, I went to the ophthalmologist. The good news was that no, there was no retinal involvement.  The bad news was that I was developing a pretty sizable cataract.  I'm in my mid-fifties, which is young for this sort of thing, but there we are.  I had a mild infection in that eye, so he prescribed drops and told me to come back in two weeks.

Within the two weeks, I started seeing rainbow halos around lights.  The good news was that the infection was gone.  The bad news was that the cataract was getting rapidly worse.  He referred me to the cataract doc.  A month later, I went to see the cataract doc who took one look and pretty much scheduled me for surgery.  It was a bit more involved than that, but it really came down to two choices, a distance-only implanted lens or the newer multi-focal implanted lens.

After hours of research and long talks with my doctor and his surgical assistant, I opted for the newer multi-focal lens.  I knew going into the operation that it might not solve all my vision issues in that eye, but it should help a good deal.  The surgeon had two openings in his schedule.  The first was the Monday after we moved my daughter back up to college and the second was two weeks later.  I opted for the second option.  Unfortunately, that gave me time to worry about the whole thing!

Cataract surgery is supposed to be one of the quickest, easiest surgeries available, with a very good record of positive outcomes.  That may be true, but it's MY eyes!  I managed to worry anyway.

Having just dealt with insurance and hospital / surgical expenses for my daughter's recent surgery, I finally figured out that it's almost impossible to forecast the expenses for a surgery.  Why it's taken me this long to realize that, I don't know, but I was tired of hidden expenses I didn't know about until months later when I'd get a bill from someone I'd never heard of for services I had no idea were rendered.  This time, darnit, I was going to be prepared.  Especially since the multi-focal lens is considered by most insurance companies to be elective surgery.

The short version of the story is that I still have no idea who did what or what I owe.  I got the name and contact information for the anesthesiologist and the surgical center.  After bouncing around a few people, I did finally get an estimate for the anesthesiologist - a first since I've never been able to get one before.  I got an estimate from the surgeon.  The surgical center wouldn't talk to me until the Friday before the surgery when I was out.  So I've yet to figure out what I owe them.  And are there others?  Pathologists?  (That's a big one, by the way.)  Lab fees?  Fees for sitting in the waiting room?  God alone knows what I'll be faced with.  I could get no information from the insurance company as to what they'd cover.  All I got was a form letter with a repeat of the policy.  That much I could have read for myself.  I got no help at all as to what they would cover and what they wouldn't.  We're two weeks out from the surgery and I still don't know.

So why does this happen?  I don't know, but I think it's a combination of factors.  Most patients don't know to ask questions and the information is seldom offered and never completely covered when it is.  Each doctor, hospital or surgical center, lab, etc. does their own billing and there is no central organization that coordinates them all.  Or if there is, I've never found it.  Since patients aren't awake for most procedures, they have no idea who was in there doing what or what went where or much of anything.  Most of us don't want to know.   Most of us us pay every bill presented and never question the insurance coverage or whether the bill is even valid!  There is a huge disconnect between patient and the medical community and no apparent way to bridge it.

Gentle readers, if you're about to tell me the recently enacted healthcare legislation will solve all this, please save the electrons.  It won't.  It hasn't.  If anything, it's made it more difficult to get information, not less.

And that's just the financial part of it.  I've been waffling about outlining my experiences, but I think I'll go ahead and do it.  Just remember, this is MY story and these are MY experiences.  Your mileage may vary.

First of all, let's be clear about one thing that never came up during all my research.  I was awake for the surgery.  They tell you you're going to be put under conscious sedation and you assume that means out for the count.  It doesn't.  What it means is that you'll be sedated for about five minutes while they numb up the eye, but you'll be awake for the procedure itself.  I didn't find this out until five minutes before the anesthesiologist walked in.

Next, they put a drape over my face with only the affected eye uncovered.  Standard procedure and I understand why they'd do it.  But again, I wasn't warned of this.  I'm claustrophobic.  So in addition to the deep breathing / relaxation exercises I was doing to deal with watching my eye being rearranged, I had to cope with the claustrophobia.  Well, it gave me something to do, I suppose.

On the up side, the surgery is very fast and totally painless.  The anesthesiologist was with me the entire time keeping watch over me (that's what they do).  If I felt anything, I was to tell him and he'd take care of any pain issues or anything that came up.  Happily, I didn't need anything special at all.  I got through the procedure fairly easily.  Recovery was very quick and I was able to walk out of the center and be driven home.  My poor husband!  I was even able to backseat drive all the way home!  And that was with one eye bandaged up and no distance vision correction in the other!  Woot!!

Then came the next day and the discovery of the wrong eyedrops.  I went in for the follow-up appointment and discovered that either the surgeon's office or the pharmacy messed up my prescriptions and I'd been using the wrong eyedrops prior to surgery.  As it turned out, I don't think it was a big deal, but it added to my post-surgical worry factor.  That all got corrected, but still.  It could have been very bad.

And the lens?  Well, there's one thing that, with a degree in psychology, I should have known, but didn't and again, nobody warned me about this going into the procedure.  With the multi-focal lens, at least, I'm having to re-learn how to see out of that eye.  For six months or so, my other eye had been taking the load of all vision.  Now with the new lens, my left eye needs to take up its load again, but how?  I literally have to learn to use it.  It's coming along, but not as fast as I thought it would.  We're two weeks out.  Distance vision, which I thought would come back fastest is still blurry.  I'm wearing a distance contact lens in the other eye, so my distance vision is decent, but the new lens is not quite there yet.  Intermediate vision is surprisingly good.  Close-up vision is dicey.  It's good for most things, but tiny print is hard for me as is reading in low light situations.  I keep reading glasses for when I absolutely need them, but am trying to work with the new lens only in the left eye.  But this is a work-in-progress so we'll see where we are in a month or so.

So my advice to you?  Ask questions.  Ask a LOT of questions.  Don't be shy and don't let anybody make you feel that you're imposing by doing so.  Very few people in the medical and/or insurance business will tell you everything you need to know.  Ask.  It's up to you.  If you can't think of questions during appointments, call the office later and ask.  Keep lists.  Make spreadsheets.  Just do it.  If something doesn't seem right, ask.
If you get a bill and don't know what it's for, call 'em up and ask.  I think the more consumers ask and pound on providers until we get answers, the more the culture will change and information will be more freely given.

But freely given or not, it's your body, your eyes, your experience and, let's face it, your life.  It's your right to know and you're in charge.

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