Don't it just figure

[kitanzi]

Oh, wheeeee. The insurance company pulled the plug on the surgery, until I get an additional 4-6 weeks of physical therapy. What the hell that's supposed to do for a bone spur I have no clue. ACat talked to his HR people, I talked to his HR people (since I'm on his insurance), they gave me a phone number and explained that my doctor would have to make any appeal on this. I called my doctor and left a voice mail. I got a voice mail back from his nurse - he got some sort of faxed note from the insurance company and apparently said "Fine, she needs therapy." So, he's useless for any appeal. Maybe I do, maybe he just doesn't want to be bothered. ACat suggests that maybe he knows the insurance company well enough to know it's pointless.

So, no surgery for a while at least. When I talked to the nurse (I've lost track of which phone call this was, lots of calls and voice mails back and forth, I'm sure she detests the sound of my voice by now) she told me that I should call them after the therapy was done and she'd make me a appointment for the surgery right away. I think she meant to be kind, and let me know that they'd try and get me a quick appointment rather than make me wait, but to me it sounds like she just doesn't expect the therapy to do anything useful. I asked her as much and she backpedaled quickly, but...

So, at least another month to a month and a half on pills and ice packs, chronically short on sleep and at war with my own body over such ambitious things as combing my hair or wiping my mouth and with no real faith that I'm doing anything but wasting my time to placate the insurance company.

I was outraged. I was furious. Right now, I'm just out of energy.

EDIT: The phone number I got for the PT clinic doesn't work, which seems about par for the course. Another back and forth on voicemail, and I have a new number. I also have an appointment on Tuesday bright and early for a cortisone shot, which gave some temporary relief last time. It's something.

Comments

[filkerdave.livejournal.com]

I guess this is the bad news?

*hugs*

[kitanzi.livejournal.com]

Yeah... I was hoping to get it appealed, but obviously that's not working out. Not that I WANT surgery... but I want it fixed, dammit. This has increasingly dominated my life over the last eight months now, and I am very, very tired of it.

[joyeuse13.livejournal.com]

Stupid, stupid, evil bureaucracy. This is what scares me to death about the prospect of socialized medicine--this kind of nonsense gets ten times worse. Yeah, everyone has insurance; no one can get care.

I'm so sorry. :(

[kitanzi.livejournal.com]

Thanks... please pass this along to Aaron? I sent him notification by replying on the earlier message, but if you can also make sure he knows that would be good. I really would like to invite you two to dinner sometime - the willingness to help out on this made a huge difference in how managable the insanity has been. (Besides, I may need to ask the favor again in a month and a half. *sigh*)

I wouldn't mind the PT - hell, I'd be all in favor - if I only thought it would work.

[joyeuse13.livejournal.com]

Will do. And I'm sure we can work out the ride thing in a month in a half. :)

[joecoustic.livejournal.com]

Bleah! That's really crappy!

Hopefully you'll get a physical therapist who will do you some good though and at least give you some type of silver lining in all of this.

*hugs*

[kitanzi.livejournal.com]

Yup, that's what I'm hoping for. If the PT can help, maybe I really don't need the surgery. I don't mind proving the insurance company right on that, I truly don't! The thing is, I just don't see how PT can help a bone spur, and that's what I was told this was. Dunno, wait and see I suppose. I'm just pissed and not really having much faith in *any* of these medical practitioners at the moment.

[delennara.livejournal.com]

Actually, sometimes PT does help indeed even when you think it is a problem that needs fixing. what hurts you after all this time, is probably not the broken bone, but the reaction of the surrounding tissues. And PT may indeed be able to modify that. When I take x-ray pictures from patients, I often see formerly broken bones, which never really healed at all, the (usually small) pieces jsut got round athe edges with time. When I ask the patient if something hurts there, it most often doesn't, sometimes they don't even remeber that they once had a Trauma there.
That you still have pain, suggests that a sort of inflammation or pressure on a nerve is going on - wild guess, without having all the facts, and all, but that would explain why cortisone helped you.
Anyway, I think giving PT a chance isn't the worst idea. Surgery always has a risk, too, and leaves scars, and can lead to secondary problems, etc.
But I do understand how this angers you. It woudl anger me, too. Exspecially the way communication is not going right...and how the insurance decides about your therapy, not your doctor, would annoy me a great lot, too.
*hugs*

[kitanzi.livejournal.com]

*hug* Thank you... I appreciate the advice from your medical standpoint. It's not broken, I don't think, but certainly a bone spur fits what you're talking about too. Do you honestly think PT would be a help for this? I'm not doubting you, just confused. It doesn't seem like it ought to, but frankly I'm mostly just angry enough about the bad communication and the insurance, and the way that the doctor doesn't seem to really care one way or the other that I don't suppose I'm necessarily being objective anyhow.

[delennara.livejournal.com]

Physical Therapy is more than most people know - they are able to influence inflammatory processes with heat and cold, or Ultrasound waves, etc. Or if a nerve is the problem, training muscles in a way that that bone spur is pulled by muscles away from the nerve, might be possible, too. I am no way a specialist in that area, though.
But the possibilities of PT sometimes have surprised me. Exspecially if the patient is willing to do all the exercises it can do really good. For example (very different area though), I know of someone with about half of the ligaments of his knee ripped. He didn't need surgery, because he trained his muscles around the knee in a way that they can take over the function, and stabilize his knee.

Often the opinion about which therapy is the best does 180° swings within a few years. So different treatments might have a chance of sucess.
And one thing to keep in mind, is that the body heals things itself, but it often takes some time. I know, you are in pain, and you are running short on patience. But don't loose oyur head about it...
(like the man with the hurting leg, sho just told me "take it off, cut my leg off", after sufficient painkillers he changed his mind, though)

[kitanzi.livejournal.com]

Thank you (again!) for talking with me about it at length on filkhaven. It helped a lot. (And I have told ACat to please amputate it, but for some reason he's reluctant!)

[annonynous.livejournal.com]

Sorry this Comment is a little late coming - health care has been absorbing our time lately. :(

Two of the times that Chosen One has had PT by itself (not after a surgery) were for a bone spur (foot)
and a torn rotator cuff (shoulder). Both times it did the trick. So yes, give it a try. But considering
how this affects your ADLs (activities of daily living), if the PT doesn't seem to be doing any good half
way through the course, speak to the therapist and / or your doctor and tell them it's not working and
you think the surgery should be done. If they agree the PT's not working, ask them to tell the insurer that.

May a steam locomotive grow in the insurer's belly, blowing its whistle. (But don't tell them this. :)

Ann O. (with Chosen One)

[kitanzi.livejournal.com]

That sounds like a very good point, and gives me a compromise I can be genuinely happy with. Yeah, I was mostly angry at how it was handled, but what the hell. Today... OVFF! *bearhug*

[kyttn.livejournal.com]

ok. So Mr. MD isn't willing to do a real referral? Fine.

Call his office again and ask for a complete copy of your medical records pertaining to the bone spur. If they refuse to give them to you, remind them that HIPAA regulations require that you be allowed to review your records at the very least, and then please let me know that they have refused, and I'll give you some additional information.

Once you have the records in hand, contact your insurance company and insist on speaking to someone involved in the appeals process. Offer to send them medical records proving this is a bone spur.

Alternately, at your first PT appointment, talk to the therapist about the bone spur diagnosis and if they agree PT will not help pre-surgery, ask if they would be willing to assist in an appeal. You will almost definitely need some PT post-surgery anyway, and can go back to these people.

If you want to email me quietly the name of your insurance company, I'll see if I have any information or contacts that I can help you with. Fighting insurance is a good part or my job.

*hugs*

[kyttn.livejournal.com]

er not real referral, real appeal.

I would be VERY tempted at this point to look for a second opinion.

[kyttn.livejournal.com]

Oh yes, something else to do...
Do you have anything in writing from your doctor diagnosing this as a bone spur? If not, time to get it. Get your MD's fax number. Fax a polite request asking that he send you an explanation in writing of what he feels is going on with you, why he recommended surgery, and why he is now recommending physical therapy. Ask in your fax that they notify you as soon as this requested information is available. Call them to verify they received the fax and ask for the name of the person you spoke to. Give them 48 hours to respond. Call back and ask for the status. Either hand-deliver or send return-receipt requested a copy of the same letter.

Your MD will find it far easier to have his front office send the paperwork for the appeal.

[kitanzi.livejournal.com]

That's no bad idea.. but it will have to wait at least until tomorrow. Frankly, I'm out of cope for today.

[kyttn.livejournal.com]

If I can do anything to help, including playing insurance bully on your behalf, let me know.

*hugs*

[kitanzi.livejournal.com]

You know, I just may take you up on that... it's a very kind offer, regardless! :)

[(Anonymous)]

I just realized, unless I can be sure to get them to do it TOMORROW, I'd better wait until after OVFF. Otherwise, the fax comes in to work for me, I'm not there, and it probably goes missing. (And possibly irritates my supervisor, dunno.) I like the idea, I do, but I think the full court press will wait until after OVFF. But if you'll be my cheering section, I'll damn well do it. :) *hug*

[klrmn.livejournal.com]

if you decide you'd rather have your PT at the hands of a chiropractor...granted, this may or may not help in terms of getting the OK from insurance to do the surgery, but looking at the problem from another direction may have more results...

[madfilkentist]

Doctors vs. insurance companies ... not fun. I had a small does of the same when a fax from the insurance company, claiming a form had been filled out wrong, went awry. As a result, my prescription was held up for over a week. My medical provider, Dartmouth-Hitchcock, didn't want to do anything but wait for the reply from the insurance company to magically appear. When I said that was unacceptable, they gave me the number of a person who supposedly deals with resolving issues; she told me, "I don't know what to do." I suggested that making them talk to the insurance company was what she should do.

Eventually I did get the prescription approved, but only after repeatedly nagging several people, and after paying for a week of pills out of my own pocket. Even then, they didn't apologize or offer to reimburse me.

Nagging is a good idea, though. Have the doctor explain exactly why physical therapy is sufficient treatment for your pain. If he's useless for an appeal, he's useless as a doctor.

[kitanzi.livejournal.com]

I may well do that. Kyttn had a number of specific suggestions along those lines, and she deals with this kind of thing a lot. I just have to scrape up some more cope, since I'm temporarily out. Maybe tomorrow.

[catalana.livejournal.com]

Oh, I'm so sorry to hear this. *hug* I really hope you manage to get this fixed; I hate insurance companies so much!

[callibr8]

So, at least another month to a month and a half on pills and ice packs, chronically short on sleep and at war with my own body over such ambitious things as combing my hair or wiping my mouth

Oww.... unfortunately I can join you in the "continually at war" chorus just now. Don't it just suck?!

Meanwhile, I have discovered that by going downstairs backwards, I can hang onto the right-side-only handrail and have good control of my motion, without odd cross-body twists. This is working better than any other strategy I've used.

I wish you similar luck in trying and finding adaptations to make necessary everyday tasks a bit easier.

[kitanzi.livejournal.com]

Thank you, and I sure hope you feel better soon! I'm mostly working at becoming as left handed as possible.

[maedbh7.livejournal.com]

Fuckers. You'll be suing them if the PT makes the matters worse, right?
*hugs you lots and gently*
More hugs in person in T minus 50 hours. -H...

[kitanzi.livejournal.com]

Bet your ass. :) Better yet... wanna help me mulch them?