Friday, May 25, 2012

Real Authority vs. Pre-Authorization

Welcome back!  And welcome to the tale of our latest trip on Mr. Toad's Wild Ride.  It's been a humdinger.

As many of you know, late last month the doctors decided my son, K., would need another surgery.  They just could not say when they would be able to do it.  Every week delayed meant a reduced chance that he would be able to recover in time to regain his teaching post in the fall.  

Like most of you, we are not wealthy.  No job for K. means no paycheck, no health care coverage, no ability to make house payments, etc. Bleak prospects.  For K., the kind of surgery necessary would require approximately twelve weeks recovery time, due to the need for "scar tissue maturation" so that he could sit all day while teaching from his wheelchair.  We were running out of time.

Finally he was given two potential surgery dates:  May 21 or June 4. The June date meant he would not be ready to resume work by the beginning of his school year, which is in early August. They said there "might be an opening" on the May 21 schedule, but it wasn't looking good.  June 4 was the likely date.  Not helpful.  

With a May 21 surgery he could, just barely, make the school year start date and he had already been informed that his position was no longer assured, due to his continuing medical leave.
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Praying.  Waiting. Praying. Waiting. Praying. Waiting. ........

On Friday, May 18 at 3:00 p.m. we received a phone call from the surgeon's office that they had an opening on the Monday morning schedule - but oops - they had not yet obtained the required pre-authorization from the insurance company.  

Really?  Seriously?  They had known for over three weeks that he would need this operation.  How was this possible?  

The surgeon's office administrator (P.) asked if K. would call his insurance rep and request an expedited pre-authorization.  Whaaaat?

I worked in healthcare administration for over fifteen years and I had never heard of such a thing.  The patient asking the insurance carrier for his own pre-authorization?  And late on a Friday afternoon for a proposed Monday morning surgery?  Were these people crazy or just plain incompetent?  (Rhetorical question.)

But desperate times call for desperate measures and thus we began working the phones.  Literally, several times K. was on his cell phone while I was on the land line or my cell phone while we spoke with case managers, patient advocates, health care administrators, back to P. at the surgeon's office.  It was a two hour marathon which by necessity ended at 5:00 p.m. as all their offices closed then.  And we still had no pre-authorization.

Some people think that, if you are a Christian you sail on through these things with a plaster-saint smile plastered on your mug.  Dream on folks.  K. was furious with frustration, and I was on the verge of tears at any moment.

At about 7:00 p.m. the OR coordinating nurse from the local hospital called to confirm pre-surgery orders, no food or drink from midnight Sunday, etc.  We were told the OR was reserved and he was on the schedule for Monday morning. We hesitantly mentioned that we did not yet have the pre-authorization for the surgery.

"Oh.  Well, now that is a problem," the OR coordinator said gently.

I wanted to scream, "Ya think!"  But I did not.  Instead we said, "We understand, and we are working on it."

Saturday and Sunday were excruciating.  The hours crawled by while we waited for 8:00 a.m. Monday to arrive, so that we could once again make calls to try to obtain pre-authorization.  My son's usual case manager, a kind woman and experienced R.N. within his insurance company, who would ordinarily have been able to sort this mess out, was on days off and unavailable.  And for a very good reason.  She was out of town attending her son's college graduation from UC Berkley.  
Thus, on the last gasp Friday evening, the unknown case reviewer who could issue the pre-authorization had refused to do so, claiming he had not received the clinical notes from the surgeon's office.  P. at that office had faxed them - twice - so they were either floating out there in the ether, or they were buried under dozens of others in a fax in-tray somewhere.  And at 5:00 p.m. on a Friday, no one was going to go looking for them.  S-w-e-l-l-l......

At 7:59 a.m. on Monday morning we began the next round of phone calls.  Had the faxes miraculously appeared?  No.  Had P. called again, or faxed them again?  Yes.  More calls.

"They won't budge," P. finally told us.  "They now have the clinical notes, but say they have five to seven days to review the case and they plan to take the entire time."  P. had obviously dropped the ball, the insurance guy was ticked-off that he was being rushed and K. was caught in the middle.

At one point, K. said, "If only we could get to someone who has some authority."  I replied, "Son, I know Someone who has real authority."

From 8:00 a.m. until 8:45 we called every one in the chain of authorization we could think of.  One loop hole was that we could go through the emergency room admitting, rather than regular admitting, and technically an emergency admission does not require a pre-authorization.  But it was risky, and if denied the "loop hole" would be on the insurance company's side - they could deny the claim, and we would be ruined with an astronomical bill that was not covered by the insurance.  We were due in admission at 9:00 a.m.  The surgery was scheduled for 10:30.

At 8:50 K. looked at me and said, "Mom, what do we do?  Do we go down there or tell them to cancel it?"

I took a deep breath, gave God the outcome, and said, "Let's just keep going until someone says 'stop.' "

He lives just a mile and a half from the hospital, so we were rolling into admitting at just after 9:00.  We began the paperwork, handed them his photo ID and his insurance card, she pulled up the case on her computer screen and looked at us with a puzzled frown.

"I see you on the surgery schedule for this morning.  But I don't see your pre-authorization in here."

We briefly recounted our dilemma, and said that we had been told that if we admitted through the emergency process rather than through the general admission desk, pre-authorization would be waived.  We realized it was unorthodox but delaying the surgery really did carry the risk of infection to his open wound (he had already had three such infections over the prior months) and other ancillary risks.

Just then, a lady walked up behind the admissions desk, smiled, and leaned down to the woman entering the information on the computer and said, "We got it.  It just came in."

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Someone once told me that when you take a leap of faith, God always catches you.  But he often waits until you are "two inches from going splat."
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We were under great pressure, far beyond our ability to endure, so that we despaired even of life.  Indeed, in our hearts we felt the sentence of death. But this happened that we might not rely on ourselves but on God..."  (II Corinthians 1: 8-9)

Perhaps, you are "two inches from going splat" today.  Maybe you are under great pressure beyond your ability to endure.  If so, please know that God truly does care and He is there to help you.

Even if there is no miracle, there may yet be a wondrous exception to the ordinary rules.  It happens.  Yes, it does.  Until next time, when we continue with "the comeback tale"... your fellow endurance partner, Marsha

Thursday, May 17, 2012

Waiting While You Are Hurting

This morning I spent some time reading Keith Green's biography by his wife/widow Melody Green.  Then I went to the Last Days Ministry website and read some of Melody's more recent writings.  There was one statement that caught my attention.

She wrote that God will take care of us and do good things in our lives  even when bad things happen, provided we are willing to "wait while we are hurting."

Yes, well, there's the rub, isn't it?

Of course, it would be easy to say, "What choice do we have?  We have to wait even when we are hurting.  No way around it."

True.  However there is more than one way to wait, but there is only one way God can bless us while we wait.

If we wait in bitterness and anger - we just wait.  The hands on the clock go 'round, the sun comes up and goes down.  We breathe in and out - we wait.  Nothing much happens.  We just sit and wait.

But if we choose to wait in hope, in faith, in the belief that God is good and wants to share our burdens, then waiting becomes an act of faith.  

So waiting can be a passive purgatory.  Or it can become an active way to serve the Lord.  Waiting in hopeful anticipation of God's goodness does not mean that we do not hurt while we wait.  We will not always get a sudden warm wave of feel-good emotions washing over us.

It does mean, however, that we will grow in faith while we wait.  We will grow stronger and more embedded in His purposes.  Today in various war zones all over the world, journalists who want to see and hear with their own eyes and ears what is going on in those terrible places become what is known as an "embedded" journalist.

They are traveling, eating, drinking, sleeping, and running with the soldiers as they fight and live and die.

The believer can become embedded in God's purposes to the extent that even while we fight, and struggle, and hurt - we also learn and grown and become more like Him.

Wait for the Lord; be strong and take heart and wait for the Lord.
Psalm 27:14

Linda Chapman, over at Linda's Life's Journal talks about us being in "God's waiting room."  She is waiting for her quadruplet grandchildren to be born.  Their mother is waiting to hit her 28th week of the pregnancy, struggling every day to keep those babies gestating just a little bit longer.

Sandie over at the Chatty Crone also talks about us being in God's waiting room.  She is writing about some struggles she and her husband are experiencing.

And K. and I are here waiting to find out what his next surgery date will be. Another phone call yesterday yielded no solid information, only a "please wait and we will get back to you as soon as we have a date."

Waiting.  Praying.  Hurting.  Learning.  Growing.  It is all part of God's plan for each of us.

While he does not cause the hurt, He does use it for our good to help us become more of what He wants us to be through it.
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If you are hurting today, and waiting for solutions, hope you know that Someone is waiting with you.  He is able to carry you through.
Until next time, from one of your fellow "waiting room sojourners" - Marsha

Wednesday, May 16, 2012

Godly Ambition - Oxymoron ?

We tend to think of ambition as a desire for personal advancement and, indeed, that is one meaning.  However, another equally accurate definition is a desire to achieve a particular end.   

The former generally does not find favor in God's eyes as it usually involves a good deal of ego, stepping on someone else's toes to get ahead, and willingness to ignore some valid obligations in order to obtain the object of our ambition:  wealth, power, or fame.

However, the second kind of ambition is not only acceptable to God but is, in fact, encouraged by Him.  The Apostle Paul writes, 
           Make it your ambition to lead a quiet life, to mind your own
           business and to work with your hands, just as we told you,
           so that your daily life may win the respect of outsiders and
          so that you will not be dependent on anybody. 
         (I Thes. 4:11-12)

Today's society says "if you've got it, flaunt it" -  "look at me, look at me".  In this environement an admonition to make it our ambition (our aim, our desire, our goal) to "lead a quiet life"; well, it just goes against the grain, doesn't it?

As life goes on, however, we learn that the bigger house, the next promotion, the larger savings account does not guarantee any real satisfaction beyond the moment of attainment.

In contrast, what can "leading a quiet life" gain us?  There must be something in it for us, or God would not have encouraged us to seek it out.

Here are a few thoughts about the benefits of leading a quiet life.

Simplicity:  A quiet life involves fewer things to worry about.  Fewer things to clean and care for.  Fewer items to insure, store and .... oh, let us not forget ... fewer items to pay for.

Serenity:  A quiet life leaves more time for things that have lasting value. More simplicity and serenity in our lives gives us the gift of more time to become the kind of partner, parent, and friend we all long to become.

Service:  Leading a quiet life does not push us out on a limb of over-involvement, over-commitment, and over-anxiety; and it allows us to serve others in more peaceful ways.  We do not have to be the one to "chair the committee"; perhaps we volunteer to cook someone a meal, run an errand, or offer some other tangible help.

Granted, I am presently looking for value in leading a quiet life, because I am somewhat restricted in my daily activities. Nevertheless, I am honestly trying to see God's hand in the process and learn through it.

For example, this spring I had a large-scale landscaping project planned for the home we bought last fall.  Plans had been drawn and approved, cost estimates negotiated, and a start date was set.  The project was due to begin on a Monday morning, but on the prior Friday I received unwelcome news and I had to cancel the whole thing.  I was/am really disappointed.

The other day, here at K's home, I noticed a large planter on his back patio.  It had one forlorn little evergreen plant in it and a few weeds.  It looked as sad as I felt.

So off I go to the garden store, and now the planter has lobelia, marigolds, dianthus, and petunias surrounding the little evergreen, which is beginning to perk up. So am I, now that we have a cheery little corner on the patio.

Helen Keller famously said, "I am only one person and I can't do everything.  But I can do something.  I will not let the fact that I can't do everything prevent me from doing what I can."

Steinbeck, in contrast, wrote that "We all lead lives of quiet desperation."
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I don't know about you, but rather than sitting around in quiet desperation, I would rather be doing what I can.  There is value in leading a quiet life, in creating a spot of beauty where possible, in serving where needed, in keeping it as simple as the road and the load allows.

So that is my ambition today - to lead a quiet life, but not one of desperation.  I choose simplicity and service and it just could be that serenity will find me watering the planter on the patio.  Hope your day is full of quiet sunshine.  Until next time ... Marsha

Saturday, May 5, 2012

Getting the Message

Late to the party.  Again.  I only just recently purchased a copy of The Message, the Eugene Peterson's "everyman's everyday" translation of the Bible.             The Message: The Bible in Contemporary Language

Yes, I realize the earlier version of Peterson's work has been around for nearly two decades, and even the parallel study version I just purchased (NIV/Message) was issued in 2008.  As I say, I am late to the party.

But when I finally did obtain it, I dived right in.  And it is worth the dive, let me tell you.

This purchase represents, for me, another learning curve slightly different from the scripture of my childhood.  In those days, it always "meanteth what it saideth" - and much like the famous Henry Fonda line from On Golden Pond, ("Ethel Thayer, it sounds like I have a lisp when I say your name.") those of us who memorized and recited exclusively from the King James Version often sounded like we had a lithp.

In my youth we were often warned of the perils of reading the "other versions" and we were steeped in the differences between a transcription, a literal word-for-word version taken directly from the Greek Septuagint and the Latin Vulgate, versus a translation, a more loosely handled interpretation.  My own mother was more than a little askance when I bought my first copy of Good News and The Living Bible.  Nevertheless, the J.B. Phillips translation of the New Testament gave me insights that "doeth as I sayeth" never had.

So here I sit, delighted with my new study tool; pleased as a kid in a candy store.
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The Bible, the living word, Peterson tells us is the only book that reads us as we read it.  Isn't that the truth?  The living Word alone is a discerner of the "thoughts and intents of the heart."

This morning I read in Philippians (warning: I am wont to spell this epistle with two "ls" and one "p" - just ignore it if I slip up) and the introduction to it blessed me almost as much as the passage itself.

"...mostly an apprentice acquires skill by daily and intimate association with a 'master',picking up a subtle but absolutely essential awareness of things such as timing and rhythm and 'touch.' (The Message - Introduction to Philippians)

"There has never been the slightest doubt in my mind that the God who started this great work in you would keep at it and bring it to a flourishing finish on the very day Christ Jesus appears." (Philippians 1:6/ The Message)

May it ever be so.
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Note: Thank you to all of you who are praying for my son and my sister.  We are in a "holding pattern" right now on both fronts.  Will know more in a week or so and will keep you posted, as several of you have requested.

Until then, my friends, you are also in my thoughts and prayers.  Until next time ... Marsha

Tuesday, May 1, 2012

Honest Doubts

My mother used to say that God protects us by not allowing us to see the future.  Jesus himself told us that "each day has enough trouble of its own."

We arrived home, after a two-day drive back from Eastern Washington, on Saturday evening.  I had not spoken to my son, K., for a couple of days, but our last conversation had not been promising.  He had seen the doctor and was back on antibiotics for a new infection.
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The verdict is in, and it is not a good one.  He was taken back off work last Friday and will have to have another surgery as soon as possible.  A week from today he sees the surgeon for the exam and to set the surgery date.

He is discouraged, and understandably so.  I am not exactly jumping for joy myself.  As we talked (and wept together) he vented his frustration and fears, he also voiced his doubts.  His doubts about God's love for him.  About whether God truly cares about his situation.

Again, this is understandable.  Due to the nature of his injuries and the required surgery to repair the aorta to his heart, he was told there was a small chance (about two-percent) of becoming paraplegic after his auto accident twenty-seven years ago.  He became one of the two percent.  Then five more surgeries, double amputations, infections, hospitalizations, a never ending struggle as the years of his young life rolled by.

But he never gave up.  He never quit.  And he rarely indulged in self-pity.  He was nineteen at the time of his accident.  He is in his mid-forties now; and this time it is different.  He is tired.  He is worn down from struggle and pain and disappointment.

He showed me the cards his students had given him last Friday, as he explained that it was his last day at work, because the doctors had told him he could not continue.  He cried when he told me how kind and sincere his students had been about missing him and wishing him  good luck with his "next operation."  Dear Lord, in his case there is always a "next operation". Or so it seems.

However, this time is different.  The surgeon told us ( I was with him during the first consultation a few months ago) that if they had to operate again, it would be the last time.  He has "no more spare parts" as the surgeon put it.

Small wonder he is experiencing doubts.  We Christians like to put on a good face, we like to shoulder our burdens with some dignity, and maintain a stiff upper-lip when we find ourselves unable to maintain our joy.  

Nevertheless, here is my real hope and my honest conviction.  God is bigger than my son's doubts.  He is stronger than my sorrow. He is greater than the sum of our fears and disappointments.  He "remembers our frame and knows we are but dust."  He takes into account that our lives "are but a mist that appears for a little while and then vanishes." (James 4:14 NIV)

And He cares.  His love is ever present, unchanging, immutable.  It is only by his grace that I can face K.'s doubts and maintain that God is good - all the time, in every circumstance - including these in which we now find ourselves.

This dilemma of "how can a good God allow such pain and suffering in this world He created?" is not new.  Job faced it.  C.S. Lewis wrote about it in both The Problem of Pain (a rather abstract look at the issue) and later in A Grief Observed (a raw and broken personal account after the death of his wife, Joy Davidson.)

We all have doubts.  But some are brave enough to face them, own them, acknowledge them.  Some do battle with their own doubts.  I always think of the man who said to Jesus, "Lord, I do believe, help  me overcome my unbelief."  (Mark 9:24 NIV) Now that is an honest doubt.

Jesus did not reject "Doubting Thomas" - he simply met him where he was.  If you have your own doubts today, He will not reject you either.  He will meet you where you are, where you live and struggle and reach out for hope and strength to meet your day.
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I am reaching out for hope for K. and for strength to face the day. Thank you for your prayers.  Hope your day is hopeful, too.  Until next time ... Marsha