Saturday, February 28, 2015

Anti-PD1 trials and tribulations: Scans...

Have I mentioned lately how incredibly much I companies?  I HATE INSURANCE COMPANIES!!!  ALL of them.  I have paid insurance premiums for myself and my family since I was 18 years old.  I had basic regular checkups.  I had two completely normal pregnancies and deliveries.  I have been in the emergency room once with anaphylaxis to pecans, was given epi and sent home.  I have managed my asthma well through meds and exercise and have had only one doctor visit and chest X-ray due to complications.  My children had basic well child care, a couple ear infections, one rash and three ER visits between them.  My husband sees his doc once a year.  That's it.  And despite my melanoma crapola...BCBS and for a brief time, Alliant, STILL MADE MONEY on us!!!  MADE MONEY!!!!!  Yep, I actually did the math!

One of my first horrible exchanges with an insurance company was not about me.  As nurse manager for a pediatric office and coordinator of care for the more complex patients, I was setting up planned transfusions for a little guy with sickle cell disease.  As I'm sure most of you know, in sickle cell disease, red blood cells are crescent shaped, rather than nice fat round ones that can't get tangled up with one another.  Unfortunately, patients with sickle shaped cells do have clumping which can cause a crisis as these cells jam up in joints causing pain, or in organs...causing lack of blood flow and ischemia past the "clump".  If that happens in your brain, you can have a stroke...even if you are only 8 years old!!!  But, if you give patients transfusions of healthy circular red blood cells you can decrease the clumping!  Back to my story...while setting up the transfusions, I had to deal with the insurance carrier, cause Lord knows!!! - you can't just do what is right for the patient!!!  I turn in the requisite paper work.  I send in the patient's history with documentation of need.  DENIED!!!  I call.  Speak to a total bitch, who tells me that transfusions were not indicated for this patient's condition.  I asked, "His condition being sickle cell disease, from which he has already suffered a mild stroke?" She replied, "Yes.  Transfusions are not needed in sickle cell disease."  "Ma'am," I said, "What exactly are your credentials?"  "Oh, I'm a nurse!" she said.  "Really????" I say!  "Did you PASS boards???"  After going crunk on her ass and I don't know whose else, yes, the transfusions were approved.  Poor, little Frank.  I loved him and his family very much.  If only that had been the last patient I had to fight with insurance companies for!

But...back to my continued hatred....  SO.....on Wednesday a very sweet girl who works in the imaging department where I have been having CT's with contrast of neck, chest, abdomen and pelvis and an MRI with/without contrast of my brain every three months until I graduated to every 6 two years ago, since 2010, called to tell me that the brain MRI had been denied by my insurance.  (And NO!!!  These studies ARE NOT paid for by my trial, though they ARE REQUIRED by same!  Just so you know!!!)  She had provided every bit of info they requested, fought with them, had gotten them to approve the CT of the neck which they had also denied (though they had approved the others - go figure!) but could not get them to budge on the MRI.  She apologized, but there was nothing more she could do.  I call.  Not a human who actually makes decisions, mind you.  Not even a person who works for BCBS, my insurance carrier.  But, a person employed by a company BCBS has outsourced their REJECTION work to, Med Solutions.  Solutions for whom, I wonder????  She was a fake automaton who said when I inquired, that my MRI had been denied because they were not indicated more often that every 6 weeks.  Well, that's just fine honey, cause I haven't had one for 6 months!!!  Oh, oops...let me look, well no...then it was denied because 'the patient' (Yes, she actually said that...while talking to ME....THE PATIENT!) has no symptoms of a problem with their brain, despite previous brain tumors, and MRI's are not indicated just to see if a treatment is working.  WHAT the F&*#!!!!?????

Bottom line, B called my local onc, who called some A$$H@L# at Med SOLUTIONS and got it approved.  I would for an insurance company!  Don't tell me about how the woman I spoke with is just trying to make a living and didn't really make the decisions.  I know that.  Still...I would NEVER any capacity...for an insurance company.  I would clean mortar from used bricks, clean blood and muck from dental spittoons and other folks nasty toilets and something else on the side, if that's what it took to feed my family, before I would work for an insurance company. WAIT!  I've already done all those things!!!  Hmmm.....well....MAYBE....I would work for an insurance company...for ONE DAY!  What a day it would be!!!!!!!!!

Anyhow, rant over.  No...just paused....for now...

MRI of brain = clear.  Same holes.  This rattie has a brain like Swiss cheese!  Guess that's fitting.  Rest of bod.....same bumps and baubles.  I think radiologists compete with prior readers (No, Virginia, you never get the same one.) to find 'one more thing' and provide a GIGANTIC list of everything it could POSSIBLY be...including tumors...rather than a definitive diagnosis.  This one did.  A little lumpy thing on the right chest, very close to the surface, that B confirmed has been there for years, which the radiologist noted as well, and in OUR humble opinion is probably scar tissue from a clamp placed during surgery to remove the right upper lobe of my lung.  Anyhow, Weber and his peeps will get the final say...but all appears to be clear from melanoma.  Sooo...there!!!

What do you call a doctor who hedges his bets?  A radiologist.
What kind of sandals does a radiologist wear?  Flip flops.
What kind of doctor is always in the dark?  A radiologist.

You get the idea.  Sorry you rad guys and girls.  Some of you are brilliant, helpful and kind.  But, you ALL make really long lists of possible explanations for things you see on film.  I could have provided YOU that differential when I sent the patient in!!!!  You're supposed to help NARROW that list!!!

It's been quite a week.  May your scans be clear, your insurance company from another planet (cause they all suck on this one) and your radiologist have excellent vision, dedication, and precision.  Much love - c

1 comment:

  1. Oh my God! I can't believe the insurance company! @@@
    Anyway, so happy the scans are clear once again! :)