My little knee surgery saga

My little knee surgery saga

Posted on December 14th, 2020 by Scott Warnock

In the spring, as we were whiling away pandemic time, I decided to attempt to rekindle my short-lived TikTok fame by making a video about badminton.

Yeah, let that sentence sink in.

Unfortunately, in trying to please my small and ever-dwindling fan base, I stumbled in a rut and tore the meniscus in my knee.

Some fun.

I hobbled around for five months before determining that I had to address it. The surgery is tomorrow.

With that decision, I entered the insurance maze. Realize, no one was a malicious player–in fact, everyone I worked with was friendly and helpful–but the process was like a part-time job.

Once upon a time, I went to my primary care because that’s where the process all starts for these things. That makes sense. Got it. From there, I needed an MRI. Check. Then I was off to see the knee specialist.

I have good, maybe great, insurance. I work for an employer that has a preferred network. I searched the nearly 24,000-line tier 1 provider spreadsheet for a knee doc, and I found one.

I went to the office, got some x-rays and had an eval. He sent me to the surgeon. I went to see the surgeon and the NP he works with, had a more detailed eval (like I said, the individual players were great), and set up the surgery.

During the course of all this bills and paper copy EoB (explanation of benefits) forms were arriving. Sometimes I was billed. Sometimes I wasn’t. Sometimes I paid on the spot. Sometimes I didn’t. I tried to keep up, matching EoBs (they can be a bit confusing) with bills. I was also trying to leverage the waning dollars in my health care spending account–see, I’m a smart consumer!

The big day crept closer.

I of course needed a CoVID preop test. I also needed to set up postop rehab. I looked through my big spreadsheet and found a tier 1 rehab provider. When I called, though, I was told they are not “capitated” to my primary care, so, as a super helpful person there helped me sort that out–including by making a phone call to my insurance for me–I can’t go there.

I called a “capitated” rehab center. I can go there, even though it’s more expensive than the other place. Another nice person gave me a mystery number I had to provide to my primary care, which I did. I called back the primary care to give them that number for a referral.

I was feeling I was almost over the finish line, but near the end of my call about the rehab referral it was mentioned that I might need a “clearance” or “referral” for the surgery. I went from befuddled to panicked, because I thought we did that from the get-go, and then I realized I didn’t know what “that” meant! What were these terms?!

I scrambled to connect my fine primary care folks and the helpful surgeon’s assistant. There was a moment of concern, but they took care of it.

Apparently I am ready, although during the course of those conversations and the conversation with the rehab place I was also told I need a “script,” and I was initially befuddled again until I was assured the “script” would be sent out with me following surgery.

I’m an organized guy. I have a folder for all this stuff. Nice notes. A filing system powerfully behind it all.

How do other people deal with all of this, I thought? Or, wait… am I other people? Pride, indeed, cometh before the fall.

Anyway, I’m ready for the big day–I think.

But this is more complicated now. CoVID. I have to think about the implications of going to the hospital. I also have to think about the implications of asking health care providers to do this job when they might be doing other jobs.

I’m at the eve of the event (who knew this would be the biggest “eve” of the month for me?). If something prevents the procedure, I’ll realize there are more important things in the world. I’ll wait, and then re-open up my little file system and figure out where we left off.

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Scott Warnock

Scott Warnock is a writer and teacher who lives in South Jersey. He is a professor of English at Drexel University, where he is also the Associate Dean of Undergraduate Education in the College of Arts and Sciences. Father of three and husband of one, Scott is president of a local high school education foundation and spent many years coaching youth sports.