Thursday, February 04, 2010

MORE rheumatologist and insurance company woes! 

My regular rheumatologist is on maternity leave again. My December appointment was canceled, and the earliest I could see her after her leave is end of June. Not acceptable as I'm supposed to see her every four months and the last visit was August 2009, so I agreed to go yesterday to the rheumatologist that's filling in, someone I already have a rocky relationship with.

The fill-in doc three years ago disagreed with my Sjogren's diagnosis, insisting I have a repeat lip biopsy (instead I had the original re-confirmed by the Mayo Clinic) and telling me that strenuous cardiovascular exercise would cure my fibromyalgia. Needless to say, I didn't go back to her. But here I am, hoping we can just note that I was there, refill my current medications, schedule the tests my regular rheumatologist wants and then I can be on my merry way.

Naturally, she sees "fibromyalgia" on my chart and ignores everything else. She proceeds to try to talk me into going on Savella, despite that it is noted in several places that I have unfavorable reactions (including permanent brain damage) to ALL types of anti-depressants. She was skeptical of the fact that I cannot tolerate dozens of medications.

Then we do the physical exam. She asks when I fractured my back. I never have, but she confused the compressed disc noted on my chart with a compression fracture.

She asks if I am exercising hard enough to elevate my heart rate, and I reply that I am not able to tolerate that but do six days per week of less intense workouts. She insists that only vigorous exercise will generate enough endorphins to conquer my pain. I wasn't gonna get into that argument again, so I gave her my best fake smile.

Luckily, because I am not her patient, I was allowed to stay on my current medication, and she set up the usual blood work. But then she dropped the bomb: the rheumatology office, which is the only fully functioning one in town, will no longer be accepting my new insurance! I already know that if I go back to the Mayo Clinic, where an excellent rheumy offered to take me as a patient, that it won't be covered either, and I cannot drive myself the three hours to get there, and my husband can't get the time off work to take me anyway.

So then I go to do the x-rays that had been scheduled. Came to find out that my new insurance won't pay ANY of the cost for them! My choices are either to pay full price on a $5000 out-of-network deductible at that location, or go to a facility my doc doesn't contract with and pay full price toward a $2500 deductible!

I decide to go back to the rheumatologist's office and see if I can get an order for the other imaging center. They hand me a filled out form and tell me I will need to call the other hospital's scheduling center myself. I was exhausted and said fine, and went home to get something to eat since my glucose levels were probably low, and the only place I have a phone is in my house.

Had a quick bite to eat and called the imaging center. They asked when the order was faxed because they couldn't find a copy. I said I had it, and they told me to fax it because they wouldn't schedule anything until they'd seen it first.

I told them I don't have a way to fax from my home, and they said to contact the rheumatologist's office again. I did, and was asked what the imaging center's fax number was, and of course I'd forgotten to ask. The receptionist grumpily said she'd see if she could figure it out and said I'd get a call.

No call, yesterday or today. And then when I was putting the x-ray order form back in my purse, I saw a note on it that said "previous compression fracture"! Now I can't decide which is more useless, the doctor or the insurance!

I am generally a pleasant person. I don't enjoy stirring up trouble, and am more than happy to comply with REASONABLE doctor's orders and REASONABLE insurance exclusions. But I only recently finished paying a two-year-old Mayo Clinic bill and am still paying on the surgery my husband had last year, and I can't afford anymore outrageous charges.

I already checked into what assistance I might be eligible for, and the answer is none, not in the state of South Dakota, anyway, because my husband is employed. His income is tiny, but we live in one of the poorest states in the US, so there are many who are much more truly needy than we. The curse of the lower middle class.

At the moment, though, I feel as though I deserve a bailout - from reality.

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