I go in for my surgery on Tuesday and I am nervous as hell. The process of getting my surgery to be paid for by my insurance, here in Israel, has been rather daunting. Just so you all understand: I am from the US and I moved to Israel just over a year ago. In the US even though health insurance is ridiculously expensive, and does not cover enough of costs, it is a remarkably streamlined process which can be effectuated months in advance and can take a few days to get set. Here the process is NOT streamlined in the least and everything takes place at the "last minute". That can be quite hairy for someone who may not have enough moolah to cover anything that may not be covered. So here is how it panned out for me.
It was about six months ago that I initiated the process of diagnosis and getting recommendations for correcting the issue. As soon as I learned it would take surgical intervention, I agreed to the surgery and began to put the wheels into motion to enable it. First, I had to wait to receive a date for the surgery. That took about a month of waiting and it was scheduled for December 25th - four months out from the time I received the date. I immediately asked what the procedure was for getting it covered by my kupah (health insurance). I was told that since my surgeon is a "private practitioner" I would need to contact the "Sharap" office at Hadassah Hospital, where my surgery would take place, and the Sharap office would be in touch with my kupah and then they would contact me. But, I was told I would not know anything until a few days before the surgery!!! At that point I explained that I needed to know at the very least how much my share of the cost would be, due to the fact that my funds are tied up in the States and it would take me some time to arrange for the release of the funds to pay for it. So Sharap understood and contacted my kupah and got me the info. In effect, they "neogiated" with my kupah about this. Ok, fine.
Last week, I was contacted by Sharap and told that my kupah was refusing to cover the surgery because I was not a participant in their Gold plan for a full year -- I would be shy by SIX DAYS on the day of the surgery! That is by THEIR reckoning, not by MY reckoning – what happened is this: when I arrived in Israel, just off the plane, I was met by an agent from the Jewish Agency and told to choose a health insurance provider. I had done some research before I arrived and I chose Maccabi. Then, a week later I attended the NBN Klita Fair in Jerusalem. I knew there would be a booth there for Maccabi and I would be able to select a supplemental health coverage plan. I went to the Maccabi booth, sat with a Maccabi representative and chose Maccabi Magen Zahav. I filled out the forms, and then went about my way, feeling secure in the knowledge that I was covered. I had been assured that all my info would be “put into the system” the very next day.
A couple of months later, I was ill and needed prescription medicine. I went to the Maccabi Pharmacy to fill the prescription. The price seemed rather steep and I said as much to the pharmacist. His reply to me was “If you were a Magen Zahav participant it would not be so expensive”. I told him that I am indeed a participant in Magen Zahav. He double checked and no I was not. So I went down to the Maccabi office to find out what was going on. There, I spoke to a lovely woman named Nochi (just so you know, I have found EVERYONE in the Maccabi office in Modi’in to be exceedingly nice and helpful). She confirmed that I was NOT a participant and there was no indication that I had ever signed up. But she signed me up right then and there. I erroneously thought my participation would be counted as retroactive from when I signed up.
So, back to Sharap informing me that Maccabi would not cover it due to my being six days shy of a full year of participation in Magen Zahav. The Sharap office suggested that I needed to go into the Maccabi office and ask them for a “kitzur” of my account (shortening of it) to allow me to have the surgery and for them to cover it. This I did, that very evening. (Yes, they have evening hours!) There, I was told I needed to write a letter explaining all this and requesting the kitzur.
With the help of friends I wrote a letter which I then sent to Maccabi Surgery. It was an excellent letter, even my surgeon said so when I shared it with him. It did the trick and Maccabi agreed to cover the surgery. Great! Or so I thought. That same day, I was contacted by Maccabi and told that they will NOT cover the surgery because the doctor I chose is a “private practitioner”. I was kind of surprised (although not so much because now, I was used to expecting the other shoe to drop!). I told them that I had addressed that issue by dealing the Sharap office which had already been in touch with Maccabi and had already negotiated the fees. It was to no avail. So, I explained this to my surgeon, not knowing what else to do. Maccabi wanted me to choose another doctor – and I would NOT do that. My surgeon is the top doctor in the field and I trust him implicitly. I would not choose any other doctor.
Well, he came to my rescue. He told me that another doctor who will be assisting him would be the name we would give to Maccabi. Maccabi would cover him. So, I did give that name to Maccabi and sure enough they agreed to cover him. I suspect this is a game that is routinely played by the doctors and insurance companies here.
But now, Maccabi requires a new hafnaya (referral) naming the new doctor. Again, I turned to my surgeon who told me “No problem, we will get a hafnaya to them on Sunday.” Mind you, my surgery is now four days away and on Sunday will be two days. When I was told initially that everything gets arranged at the last minute, I realize now that was the honest truth!!
Personally, I think it is a very bad way of doing things. An individual who is facing major surgery, scary and painful surgery is already stressed out about that and working hard to be calm, relaxed, and positive – which is crucial when one is about to undergo anesthesia and surgery – does not need the added stress of worrying about whether or not the surgery will be covered by their kupah at the very last minute! It is something that should be worked out WELL in advance of any surgery that is PLANNED.
In any case, it appears that everything is working out as it should and as always I give my thanks to Hashem for His hand in it. I know he is orchestrating much of this for me!