Month: July 2017

My Insurance Strikes Back – Pew Pew –The Story Volume 2 – Part 6

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I wish to remind my readers that before I had the insurance I have, I never had to contact my health care company. As the years went by, it felt like I could
not get off the phone with them. If it was not bills, MRI for my brain, MRI for my spine, approvals for medication – it was approval for my procedures. The first few months I did not have a problem with them, but the following years felt like a battle of wills. Stupidity vs Perseverance. I had to defeat the stupidity of my insurance in order to obtain the medical procedures I needed. Up to this point, I won with no
issue, but what came next was that I lost my first battle … well, … well almost lost:

I now had an MRI proving that my back pain was not exaggerated, and there was clear-cut reasoning behind why I felt the pain that I did. To remind you, I had two spinal bones with severe arthritis and two bulging disks, with other anomalies, that we were not concerning ourselves with at this time. The disks were L4 and L5 with surrounding areas. The next day when I got home I called my PCP and left him a message begging for help to get an appointment to see a back specialist ASAP. I knew if he made the phone call for an appointment I may get in a lot faster than if I did.

My PCP did just that. He set up an appointment to meet a specialist in
a few weeks instead of a few months. The following weeks were almost
unbearable. The pain tearing down my back into my legs plus pain shooting upwards from both of my ankles, made for a hurricane of pain through my body. I lay on the floor all day and night. My pain manager prescribed more oxycodone, to help me get through the nights until my
appointment. I did not want to take more medicine, but I had no choice. Other options were illegal and could get me kicked out of the practice.

As the weeks went by the day finally came when my wife and I found ourselves in a new office, waiting for a new doctor, and explaining our whole situation to a new nurse before the doctor came in. Her only
words as she heard our disgust with a new problem and exhaustion of another doctor visit were that she was sorry, and she hoped they could do something for me to help relieve all the pain.

She left the room.  Amanda and I did not talk at all. Amanda sat on the chair to my right slumped down into the seat with her phone, half paying  attention to it. I sat on the table that at this point I figured only
one company made and sold to every doctor I had ever seen. As I waited I filled my time with kicking the step stool around, making more noise then I should, until Amanda stated to be quiet when she
heard voices outside of the door.

I flipped the stool right side up with my feet, disregarding the pain that was rolling up and down my body, as soon as the door handle was pushed open, and my new doctor entered the room.  He introduced himself, read the computer screen the nurse was looking over and turned my way with a model of a spine in his hands. He first apologized for everything I had been through.  His bedside manner was very professional, endearing, and comforting. Using the model, he explained what was wrong with my spine (which I described earlier in this blog entry).  He also stated that the reason he believed I was having pain almost all over my body was because I had a disease called Complex Regional Pain Syndrome. A disease that usually starts in a thirty-year-old patient brought on by a trauma that never has healed. He stated that the fractures the surgeons had made in my ankle over the last eight and half years never healed correctly.  He knew year after year I was being fractured again for another surgery. He stated with this and the pain in my spine my brain had gotten so used to pain that
any type of sensation was being interpreted as pain. I then immediately asked him if this was the reason that wind on a spring day or a fan on low blowing across my legs caused so much pain I had to cover them with a blanket.

He paused and looked at me and stated that was one of the key symptoms of this disease. Amanda and I  sat there stunned for what seemed to be ten minutes as he typed in his computer. The next words out of my mouth were, “Thank you!  I have been dealing with this for years and no one had given me a diagnosis”. My pain manager and Dr. Treaster stated I might have it, but they were not experts in it. He was. I could not believe it. I had a diagnosis. I made him write it down on a pad and I laminated it when I got home. It is displayed on the fridge to this day.

However, before I had the satisfaction of putting up a diagnosis of my pain on the refrigerator like a child bringing home a good test grade from school, I had to cope with his informing me that I was going
to need shots in my back. The shots would be administered at an outpatient facility close to my house and they would make the appointment very soon for me. He stated that the shots should help my
legs and back as they numb the area and help the inflammation between
the joints.

For the first time in long time, I was hopeful. I thanked him profusely and apologized to the nurse for my unenthusiastic attitude before the doctor came in. Amanda and I were thrilled. I was going to get shots, and they made the appointment two weeks on a Wednesday from now.

Can you imagine how happy I was? There I was lying on the floor in pain the next two weeks with a smile on my face. For the first time I had a diagnosis, and an appointment that was going to help not only my back, but my legs, leaving worry just about my ankles and the tumors in my head. I was delighted. I told everyone of my incurable-disease diagnosis, incurable yes, but treatable. I just couldn’t wait. It was like waiting for Christmas, almost better. Two quick shots and then the pain should subside.

I remained jubilant, I was happier than ever, until . . . I think you guessed it, in the mail so very unexpectedly, was a letter from my insurance stating that the procedure was not medically necessary.  A procedure that had been recommended by the hospital they own, a procedure that was recommended by a specialist who only deals with spines. Two doctors had stated that I NEED these shots to help me. However, the Wizard behind the curtain, called the medical managers, said I
did not.

Now I knew for a fact from the last time, that they did not look at the paperwork, so once again a phone call was placed to my appeals coordinator .  When she picked up the phone, I think I heard her sigh.  She heard, “This is Doug Donnangelo again, and I swear you guys do not know your ass from your elbow.”

What’s going on?”, she asked.

I told her about what happened and that treatment that I needed that was covered under my insurance had once again been denied by a medical manager who had never seen me; treatment that had been recommended by two of their own doctors who had examined me, knew what was wrong with me and knew the treatment I required.

She quickly began typing. As she typed, my jubilation ended and all I saw was red and I let loose, “How the hell can you guys say something is not medically necessary when your own doctors said it is? We know from our last conversation they did not look at my chart, we know they denied it hoping that they would not have to pay for it. We also know, I am going to win this, no matter what it takes, a lawyer or me rolling over their stupid asses, one way or the other.”

Once again she took the comments in stride.  She must have a technique to block out this type of aggravation over the phone or she heard it so much she got used to it. All I knew was that working for a company that declined coverage for the legitimate medical needs of their customers, and taking calls from them while they dumped their anger on me did not seem like the kind of job I wanted.

She placed me on hold for what seemed like an hour, as my blood pressure skyrocketed and I experienced an adrenaline rush triggered by my anger that would have enabled me to split a car in half with my bare hands.  She got back on the phone and by her tone, it seemed to her she had an answer that would satisfy me.

“Mr. Donnangelo I know you are upset, but we want the best medical solution for you, our medical manager believes that you need to try physical therapy first.” She waited with baited breath for my answer.

After a minute of unsuccessfully trying to calm down, I replied, “Are you guys assholes? Are you hoping senior citizens just accept your answer so your company saves money? How can he suggest that? How does he know more than my doctors? Does he know I have been lying on the floor in pain for weeks and I finally have a diagnosis and he thinks physical therapy will help me!!!!.”

“Yes, understand, we reviewed your file. . . . ”

Before she could finish, I continued my tirade, “Does your doctor know I already have had 8 years of physical therapy on my body? Oh wait he doesn’t because he didn’t do his due diligence!!!! Get my shots approved now!”

“You had physical therapy? Let me see…oh yes here it is…yes it shows you had a lot of physical therapy, I will get your records and present them to him.”

“You have to be kidding me! Okay… Okay…. Look my appointment is Wednesday next week. Today is Thursday.  Get it done before my appointment, because if I have to delay, I will be lying on my back once again, for weeks, until they can fit me in. Tell that asshole he better approve it, before I have a lawyer and myself run over his ass so fast, he will not know what hit him.”

I found myself once again, wanting a phone I could bang down, wanting to make a loud noise, but instead it was a press of a disconnect button. I was out on my deck fuming. Amanda could see I was about to flip over a table or burn a shed down.   Before I could contemplate how to release my anger, my phone rang. It was my spine doctor.

“Hi Mr. Donnangelo. I am sorry to say your shots were denied, and the doctor, who usually never makes phone calls, called the medical manager to let them know you need those shots, but it did no good. They upheld the denial.”
I told her, “Don’t worry I just got off the phone with them.  Tell the doctor I am truly appreciative of his making the phone call, but you leave those fucking assholes to me. Once I run their asses over the phone it will be approved, trust me.”

“Oh! You already know. I am so sorry, Insurances can be so difficult sometimes. I truly am sorry, but the doctor really did try”, she replied.

I commented back “Don’t worry about it, let me handle it, just let him know once again I appreciated it. I will have it approved or they will regret it.”

“Okay, just keep us posted and good luck. We were shocked too when it was denied, you really need these shots.”  I thanked her and told her once again, not to worry about it.

A few days passed and it was Monday, two days before the appointment.  I called the appeals coordinator and left a message. I tried two more times that day and could not get through. How I stopped myself from punching a hole through the wall is beyond me.  I was able to control my frustration with pure will power.

Tuesday morning came. The phone rang around 9 a.m. and on the other end was the appeals coordinator. “I have good news Mr. Donnangelo. I received your physical therapy notes and I know there is enough here for you to win your appeal to get your shots.”

“Great….. My appointment is tomorrow.  Get it done immediately, please.”
“That is the problem, the only medical manager here is the one who denied it. It is hospital policy that the medical manager who denied it cannot see the appeal to overturn it so it won’t be until Thursday.”

“Are you telling me right now, I am going to have to lie down on the floor another two weeks until the doctors can fit me in, because the jack ass who did not spend three minutes looking up my record and denied my shots was proven wrong?  Proven wrong by my  medical records. But it is your company policy that when medical managers make a decision that is overturned they can’t change it themselves! You cannot possibly be telling me this. I was a manager for a bank.  If I made an error my company let me be a big boy and fix the error or override it.”
“I know Mr. Donnangelo and I am truly sorry but your shots will be approved, just not until a few days.”

“Oh my god, do you know that your company is the dumbest company I have ever worked with? I truly appreciate your help getting this approved, but how do you work with such incompetence? I mean from claims, to approvals, and to appeals. I have nothing but issues. I did not have to contact Highmark one time. What the hell is wrong with you guys? Look, it is time for me to have a sit down with your CEO. Thank you, but I have to go.”

I hung up right away, rescheduled my shots for two weeks later. I spent the time during those two weeks, refining my letter to the CEO, and to my surprise within a day I had a meeting set to meet the vice president. My dad and I could not wait….

Afterword

This is a little more condensed than what I went through. It took longer and it was a little worse, but everything written is true. I could not believe Mr. Medical Manager, who knew what was best for me and felt a denial was best, could not overturn his decision once proven documentation was handed in. If you have not read all of my entries, you will want to read the next one.

denial-clipart-canstock16421140
An all to familiar word when dealing with my insurance.  However, I did not let it stop me.

 

 

Back MRI – The MRI My Insurance Couldn’t Deny –The Story Volume 2 – Part 5

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A note from myself before I begin:

It’s 2 a.m. I fell asleep at 11 p.m. for the night.  The rain is causing my body to feel aches from head to toe.  I decided to wake up, pour a hot cup of cocoa, pretend I have a fireplace, picture myself dressed in a smokers jacket holding a pipe, and begin to weave what for me seems like a tale of malice:

Amanda brought me the phone and I contacted my PCP (primary care physician).  It was on a Thursday, almost a week after winning the brain MRI appeal.

I lay on the floor in absolute agony.  The pain went up and down both legs and into my lower back, as if an evil being from within was striking my body with lightening.  I couldn’t move and Amanda did what she could.  I loathed going to the ER.   I was told by the secretary that she would take my message and pass it along to my doctor.

I knew that she would.  This is one office in which the doctor, not a staff member, actually gets back to me.  In this way he keeps me as a patient.  He did not call me back the same day.  I did not expect him to, as he was doing his rounds at a local nursing home, and from what Amanda told me from prior experience, can become very busy.  So, I decided to just lie there, like a fish at a bottom of a boat, flapping  my extremities once in awhile trying to find a position that led to the pain being less like being stabbed by a dagger and more like being jabbed by a butter knife.

That night I was dosed up with enough pills to take down a rhino.  I woke the next day in the same position on the floor that I had been in the last 24 hours.  All of a sudden the tumors in my head felt like an afterthought.  As the morning hours went by, I was not disappointed by my PCP.  He called and we talked.  I told him I needed an MRI.  An X-ray wouldn’t do.  After many years I knew what I needed.

He replied that my insurance would never approve an MRI order from a PCP.  It needs to come from a specialist.  We argued back and forth, but I could not get him to submit the MRI request because he was certain they would require me to go see a specialist and would not approve it.  He went on to explain, the denial would increase the paperwork that would need to be filled out which in the end I would need to seek out a specialist anyway.  Convinced he was correct, and experiencing what I went through in the last few weeks, I agreed it would be denied and ended the call.

I started to call specialists in the area.  The earliest appointment I could find was months away.  I called my PCP back and he stated he could put it through and he would get back to me.  A few hours later he reported that what he had anticipated was true: that I needed to go to a specialist and the MRI was denied.  I thanked him, and then pretended in my head to slam down the phone in disgust.

This immediately provoked another phone call to my appeals coordinator who had handled the request for the Brain MRI.  It was getting late and I knew she wouldn’t pick up, so I left her a message:

“This is Doug Donnangelo again. Your company once again is not looking out for my health and has denied an MRI for my back that my PCP tried to get through.  I have been lying on the floor for two days, not being able to move.  At this point I have met my out-of-pocket expenses for the year.  I will now proceed going from ER to ER until I get an MRI.  I am going to cost your company much more money than what they were trying to save.  Have a good night.”

Amanda was already working in the ER and it was getting late at night after the phone call.  I could barely move, and tears were almost rolling down my face. This was after taking an oxycodone to dull some of the pain.  I reached out to my father who lives across the street and asked him to take me to the ER.

Dad, who taught me how to never back down and be relentless, drove his SUV around the corner and up the street to pick me up.  I called the hospital, something I rarely do, and told Amanda we are coming for an MRI.  She stated hardly anyone was there and that it might be a good time to come if I was in that much pain.

It took 20 minutes of a very agonizing car ride,  sitting up.  But once we were there I was able to check in and get put into a room at 9 p.m.  Amanda stated she could not help me since she was family, and told my dad that she would be taking me home, and thanked him for dropping me off.  Dad said good luck, and turned around and left.  I could see the disgust in his face as he contemplated this new pain over my body.  The spreading of whatever this was never seemed to end.

Amanda warned me that since it was late evening, the doctor would have to ask me questions, and that they could think I may be fishing for pain drugs.  She left the room and turned out the light.  Within the hour a lovely nurse came in and took my vitals and asked me preliminary questions and told me the doctor would be right in.  That usually meant between one to ten hours.

As the hour went on, they were getting busier and busier and ten o’clock passed into 11 until the doctor came in.  He was a little older, longer hair, and had a  Dr Know-it-all face and attitude.  He began asking me questions about the pain. When did it start, how bad is it, etc… I looked at him and stated, “I know my body.  The pain is bad, and I am not fishing for pills.”

It was as if being married to Amanda, an RN on staff, meant nothing. But I could understand why, so I grabbed my bottle of prescription oxycodone out of my pant pocket and threw it on the bed.  I said, “There are over a 100 tablets in the bottle, trust me, I don’t need your pain pills.  What I need is your MRI.”  He looked down at the bottle and said, “Well, you certainly do not need pills. I will see about the MRI.”

12 o’clock went by and he came into my room, interrupting The Running Man with Arnold on TV.  He said he finally got the MRI approved, but he did not think the results would show anything, and as soon as they had an MRI machine available he would get me in.  He still seemed smug, as if he were thinking I was just another patient exaggerating my pain and making a big deal out of nothing.

The movie ended with Arnold saving the day once again.  I watched it from beginning to end, minus a few interruptions to have my vitals checked and chit chatting with the wife.  My back was not feeling better, but the bed was soft and helped a little.  As the fifth maybe even sixth hour went by I was injected with Dilotin, a pain drug to help me get through the MRI on my back, and finally went down for my test.

The drug did not take effect, I must have been used to pain medicine – but I did not tell anyone. I just wanted it over with.  I was wheeled down to the MRI room, where it looked to me like the first MRI machine ever created was waiting to scan me.  This was the first time I thought, Hopkins truly has better equipment.

The MRI took another hour. Time was starting to slip away as I was getting tired.  I couldn’t sleep because my lower back felt like I was lying on hot coals.  The medicine he gave me had no effect during the whole session.

I was finally wheeled back to my room to wait for results.  It was 3 a.m. or at least around there maybe 4 a.m. when Amanda walked in and stated she could not say anything, but the pain wasn’t in my head.  She looked at my results and shook her head and stated wait till the doctor comes back in to explain.

Dr. Know-it-all came in a few moments later and stated that he was surprised by the results.

He stated my L4 – L5 vertebrae have severe arthritis and I had bulging discs.  He said I will have to see a specialist.  He added I will need shots into my back to help with the inflammation.  He also stated that my back shows some other issues, but nothing in the results that was worth worrying over except what he had described.

I did thank him.  The staff was very nice, I saved a few months waiting to see a specialist by going to the ER and getting the MRI pushed through.  I knew it wasn’t in my head, at least regarding my back pain as well as my legs.  I had concrete evidence I could take to a specialist, instead of going and having the MRI ordered and waiting again.

By the time  I was discharged, Amanda was done working, she took me home, and I popped a few pills.  Later, I talked to my pain doctor and he increased my dose and told me to continue what I was doing.

I made a phone call to my PCP and left a message about the result to inform him and to schedule a specialist at OIP, the place where Dr. Flash works, the doctor who performed my first operation on my right ankle.  My insurance really limited me on which doctors I could see in the area.  I had no choice, I had to go back to OIP if I wanted maximum coverage.

The last thing I did was call my appeals coordinator and gave her the results. I told her this is the second time in a week that my insurance tried to get in my way, and the second time they were wrong, and that I hope they enjoy paying the ER bill…

Afterword

 The battle continues, I have to say it never ends.  Well one day it does, but for now the battle was on.  I went from one battle to another.  It was taking its toll on me and actually it still is.  This entry is another example of doing what you feel is right.  Doctors truly went from GODS in my mind to guessers.  Insurance companies went from ambiguity to a road block.  However, none of this was going to stop me from trying to feel better.  Nothing.

We are only a few entries left to present time. Once I am caught up, I will be expanding my blog with more information to help people understand insurance, EOBs, disability equipment, and much more.

image
My spine MRI from that night.

Brain MRI 2 “Insurance Company’s Attempt at Money Over Health…DENIED” –The Story Volume 2 – Part 4

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A note from myself before I begin:

I honestly believe that even though I went through 6 surgeries, countless months maybe even years of physical therapy, and complete disappointment that none of the surgeries worked, this is where the true fight and horror of my disease begins and continues.  Almost to the point I was going to stop this blog.  I hold onto my strength and the people that are left around me, although few, to continue to tell my story.  (warning profanity ahead):

You may recall from a previous entry, that I had to battle with my endocrinologist to have him prescribe a brain MRI last year.  His main complaint was:  The results showed there was an issue, but he honestly believed that my insurance company would not approve the MRI.  I argued with him to prescribe it and told him I will take care of them.  He snickered and said okay and wished me luck.  Within a few days of making phone calls to them. I had the MRI approved. It honestly did not take much.  The results were surprising.  He stated only 5% of the people will have an issue with the pituitary gland.  I scolded back that with my Donnangelo luck, if there were a 5% chance something bad were going to happen, it was 100% chance it would happen to me.  It did.  I had a non-cancerous very small 2 mm tumor on my gland.  However, they could only watch it because it was too small.  It has to be 10 mm before anything can be done.

A year has passed since then in my story.  I now sat in the same office.  However, this time my endocrinologist agreed immediately to prescribe the MRI.  I am not sure if it was to see if the tumor grew, because he stated he doubted that it did, or he knew I was going to fight until I got my way.  I was not concerned about getting approval because it was approved last year.  As the appointment ended he handed me the script after going over my new blood tests confirming that signals from my pituitary gland were still not “firing”

When I got home I told Amanda that he did not have any issues this time and he must have learned his lesson from last.  Amanda laughed and said, “Probably.”  She then asked about my pain level.  I told her the pain from my ankle had gone up my right leg and started to go into my left leg, and I could start feeling it in my back.  It was not too bad, but at times it seemed that it was getting worse.  One thing for sure, with no explanation at all, it was starting to spread over my lower body.

A few days passed with nothing to mention,  until the mail came about 5 days later.  I could not schedule the MRI until the approval was given by my insurance.  I knew it was going to take a few days so I did not worry about it, I just concentrated on keeping my pain levels down on the least medication as possible.  But it was getting harder to keep below or at my minimum recommended dosage of opioids.

I opened the letter, expecting to find the approval, so I could schedule the appointment.  However, for the first time, the doctors who told me that the insurance company would not approve procedures as easily as my previous insurance company were proved right.  I received a denial of treatment for my MRI.  They thought it was not medically necessary.  In an instant my pain was gone, because for the moment disbelief and rage filled my body.  Who were they to deny what an expert thought I should have?  I already have a tumor. I need to see if it got bigger.  How a company can be so ignorant is beyond me, I thought.  What was their thought process, how can they make this decision, just how incompetent were they?  This is a follow-up MRI of a tumor that already exists!
One thing I miss, is the old phones.  The ones that hung from your wall that were heavy that you could pick up the receiver and slam it down to hang up when you were mad.  All I had now was a cell phone, where you pressed a button to hang up and if you slammed it down, you would probably break it.  If it was back then the phone would have taken a murderous beating.  I called the member service line.  They were no help and told me that coverage was denied.  I told them, “No shit.  That is what the letter says.  Fine, if you’re not going to help me I will do this my way.”  I slammed the phone down in my head, but in actuality I pressed the disconnect button, the feeling just wasn’t the same as the old phones were.

While reeling from the contents of the letter I noticed that it stated on the other side that I had the right to appeal and to call the number on the back after writing a letter explaining why I thought it should be approved.  I had the “right” I thought.  You’re damn right I had the right. We are talking about my brain, and as far as I knew they were not using theirs.

I called the phone number on the back. A lady picked up the phone and transferred me to their appeals department where I would be assigned a case manager.  Boy do I pity them I thought, while I was waiting for them to pick up.  After only a few rings a lady picked up, and with a calming tone asked, “How can I help you?”

Calming tone or not, I was not in a good mood. I was leaning against a railing outside on my deck, so I would not waken my wife who was asleep, or scare one of our cats that is very skittish.  I stated, “You can help me by telling your company to get their heads out of their asses and approve my MRI.”

“Ok sir, I can see you’re upset (really, her perception was amazing), let me look up your file.”

I gave her all the information she needed, but as she typed on her computer, I continued my tirade. I lost it.  All the disappointing surgeries, lack of recovery, and multiple diagnoses that I had experienced culminated into an explosion over the phone.

“They have to be either the greediest, dumbest, or most incompetent company to make this decision.  How the hell can they tell me I do not need a procedure, when the doctor who knows me much better says I do? Do you fucking think for one tenth of a second, I am going to let them get away with this?”

“Mr. Donnangelo it looks like it was denied due to medical necessity.  I need you to write a note…”   I interrupted, “I already have a letter written, give me your email address and let’s get this approved ASAP!”  as the fury inside me was still building up to maximum level.

She gave me her email, and stated that though it was Friday, she hopes she can get it overturned by Monday.

“Who? Who overturns it?”  I asked.

“Our medical managers”, she responded.

“Put them on the phone.” I harped back.

“They do not take phone calls, sir.” Still in her calming voice.

“They don’t take phone calls?  THEY DON’T TAKE PHONE CALLS!,” I yelled.  “Who are they not to take phone calls, the Pope?  Do I need to kiss their ring?  I have a tumor, I need to know if it got bigger.  My doctor sent you those documents.  Imagine the lawsuit if you do not approve it and my tumor got bigger.”

 

“Oh, you know you have a tumor, and this is a follow up? Sir, to be honest we do not even give the first approval.  It goes to a separate company.  They actually do not look at your file or prior records,” she responded.

My frustration changed to shock. “Are you fucking telling me that you have another company who does not know me, but denies my claim without doing their due diligence of finding out why I need the procedure?”

“Well that is why we offer the appeal”, she answered back.

“An appeal! You shouldn’t have to appeal! I never in my life had to appeal until I received your insurance.  Actually, I never had to call my insurance company until I got your insurance.  The doctors were right.  I felt that the insurance company was stingy and has major issues approving things.  All you’re hoping for is that people like the uninformed or senior citizens will see their denials and accept them, instead of fighting.  Well let me tell you, you met your match today.  I’m disabled and basically retired. I have all the time in the world to fight this.”

“Well Mr. Donnangelo I am sorry you feel this way.  We just wants to make sure you are  getting the correct treatment you need.”

“What? No.  My doctor knows the treatment I need.  I feel you are trying to save a buck for your bonuses at the end of the year.  Look, I am tired, you guys pissed me off.  You better have good news for me Monday.”

She thanked me for the phone call (yeah, right) and hung up.   I had to admit to myself that she was an outstanding middle person.  She took my tirade in stride.  A tirade she probably gets all too often.

I had no choice, but to wait.  During the weekend, my back started to hurt really badly.  I left a message for my Internist to ask to get an MRI approved for my back.  There had to be something wrong.  I could barely move or get off the floor and my stress level was had been pretty low during the weekend, besides the increase in pain.

Those two days passed and I received a call from my appeal’s coordinator.

“Mr. Donnangelo I have some good news.  I went over your file with my medical manager and they saw that this truly was a follow-up and approved your MRI.  They could not explain why it was not approved from the beginning.”

“I told her that if they done their due diligence of reading my doctor’s notes they would not have had to stress me out all weekend on top of the pain I am going through.  I also told them I knew why they were denying their members medical services, something Blue Cross, my previous insurance, never did.”

I thanked her and hung up, so I could schedule my MRI right away.  A few days passed,  I arrived at the facility and went through the MRI process.  After another week, I was back in my endocrinologist’s office.  He told me that my tumor had doubled in size to 4 mm,  and I now have a second one.

I told him about the issue I had struggling to get coverage for my MRI and asked him, “Now what if we did not know it grew double in size?  Something you said probably wouldn’t happen.”  He stated we still had to keep an eye out for it to make sure it does not hit 10 mm. Once it does I need surgery and could possibly have issues with my vision or lose my sight.

I replied, “Great, just what I need, I told you nothing good  happens”, as I got up off the chair and left before the appointment was over.

It was around this time that I started to end appointments abruptly when I felt like it or had enough of bad news.

I went back home and told Amanda what was going on.  She was concerned, but we had no choice but to wait and continue to take the hormone replacement medicine.  I told her, “Imagine if my insurance said no and I paid for the MRI outright, with these results showing the tumor doubled in size and now has a friend beside it.  What would happen is, by the time I was done with them I would have owned them.  I should have never had to go through the stress of Friday and throughout the weekend.” As I lay on the floor, seeking some relief by assuming the only position that calmed some of my back and lower leg pain,  I asked her, “By the way, did the doctor call back about my MRI for my back?”

“No, does it surprise you?” she stated in an exasperated voice.

“No. Are you serious… that’s fucking it!  I am sick of these doctors not doing their jobs. Give me the phone…”

Afterword

I was truly stressed out and was and still am in serious pain.  Having someone trying to block my health care was unacceptable.  And all my frustration during  those six years was starting to boil over.

 What I want the reader to take away from this entry is, do not let a company dictate your health care under any circumstances.  Be your own advocate and fight for what you believe in. 

You only have one life, you need to live it to your fullest.  If you believe that there is a procedure that may help you, do not stop at a denial.  Fight it!

In upcoming entries you will see how more mistakes led to a sit-down face to face conversation with one of their vice presidents. It was most interesting what he had to say without realizing it.

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If you mess with the bull, you’ll get the horns. Geisinger was the only insurance company I ever had issues with, though they tried and tried to deny my procedures or process my claims incorrectly. They lost each time I fought them.