I've Consulted the Magic 8 Ball

MRI Jitters

My doctor had appealed Anthem's decision to not authorize a PET scan, I followed up this week with Anthem since the appeal was mailed to them April 2nd. The appeal is nowhere to be found. I had a denial of an appeal letter sent to me, but it could have been from the peer to peer review. I left voice mail with the appeal department and no-one ever got back with me. I talked to customer service and they didn't know what to do. I spoke with radiology precertification and they couldn't find it. No one at Anthem could tell me what the denial of appeal letter was denying - the peer to peer appeal, or the doctor's appeal. I think the appeal got sucked down into that giant black hole where all unpaid claims go.

I then called my oncologist because my GI doc had already ordered and completed an abdominal MRI because of the pancreatitis. I was hoping I wouldn't have to have any more testing and they could use this instead of a PET scan. They would use it, but I then needed to have a pelvis scan. I had that done yesterday. I had a tremendous headache but I got my brother to go with me to the MRI center so someone could drive.

Got the pelvic MRI done, and now the MRI center has called me asking me to come in first thing Monday (like 6:30 AM) to have some additional studies done by the request of the radiologist. When you have had cancer just having the radiologist need extra studies is anxiety provoking. I am trying to not panic (Serenity Now!) and have consulted the Magic 8 Ball on the internet, and the answer was encouraging.

The Headache is fairly bad today. I delayed taking some medication so I could make sure I could fill in at work for a gal who is off today. I'm paying for that delay this evening. I am sure that hearing from the MRI folks this evening is helping The Headache along. I threw up twice at work and there is nothing worse than puking in a toilet that your co-workers asses have been sitting on. That alone makes me nauseous thinking about it - and I'm full of phenergan!

The Belly is complaining also. It didn't like emptying in the work toilet either!

I am resolving not to obsess about the new studies at the MRI center. What will be will be, and what is already is, and worrying about things that may never happen is counter productive.

In one of the internet groups I belong to someone with the same headache type as I have said a combination of drugs is finally working for her - time release morphine and baclofen and parafon forte. She said her headache specialist thought that the baclofen and parafon forte would change the brain reaction to pain (sorta short circuit it) and it seems to be doing the job. She is young and has had this headache for years and years. I'm so happy she found some combination to help the pain!

Calm Waters Tonight

Finally My Head is Shrinking

The Headache is here but it is more distant and smooth, like evening ripples on a summer pond. I hurt elsewhere but The Headache is behaving tonight.

My headache diary was touchy to transmit again tonight - took three trys to get the silly thing to answer the siren call of the telephone. I almost forgot to even fill it out - I must make it a ritual to do at a certain time of day or I will forget and be non-compliant. I must be compliant in order to qualify. I do hope I have enough "headache days" to qualify. Not quite sure what the study sponsors consider a "headache day".... all of my days are headache days!

Tomorrow I will need to tackle Anthem again. I did a successful appeal of some ambulance bills from last year, and Anthem was to readjudicate these NOT using the "usual and customary" rate. The ambulance service which is non-participating with Anthem refused to accept the contractual write-off from these bills.

This is how modern medical billing works: If I had NO insurance, the ambulance service would automatically write off 20% of the bill. If I had their hospital system's insurance they sell, or another participating insurance they would have accepted the portion the insurance paid and written off the rest to contractual allowance. Since I have Anthem (with whom this hospital system has a long standing fight [pissing match] with) I was told I was responsible for 100% of the ambulance bill - worse than if I had no insurance at all! Their billers actually told me they didn't even want the partial payment, that I had to appeal. I won the appeal, and supposedly this was re-adjudicated but got paperwork from the ambulance service: apparently it is not resolved.

Anthem called me last Wednesday about the PET scan pre-certification problem. A lady named Coleen called just to make sure I knew I could appeal the pre-certification denial. I told her that I knew this, and complained again about their swellheaded contract physician who tried to advise my doctors on my care. That physician's job was to deny (and upon rare occassion approve) peer-to-peer review of service denial issues based on medical policy. He or she stepped beyond the bounds when he/she started dispensing opinions concerning my care.

Coleen wanted to make sure I understood they had a medical policy concerning PET scans. I am sure by their medical policy very few persons qualify for PET scans. I reminded her that policies are just that - guidelines to follow (generally to save the insurance company money) and that there are circumstances where policy is meant to bend, and by no means was I pleased that a physician who had never seen me, who obviously had not reviewed my medical record, and was not familiar with my case at all, was trying to dictate treatment instead of just administering a policy. Competency thy name is NOT Anthem. I am sure they have messed this up, or Coleen would not have called. I doubt it is standard procedure to call a subscriber especially to urge them to appeal a decision just made the prior day.

My personal opinion is that when the Blue Cross Blue Shields (WellPoint and Anthem aren't the only ones) starting going public and for profit their focus shifted from providing the best coverage at a reasonable cost to quarterly returns and stock price (which of course is what upper management likes to measure because they have a direct influence on their own stock options and bonuses). Too much managment focus on nest feathering and too little concern for their employees, quality, and their subscribers have changed the perception of excellence the Blues once stood for.

Ah well, this is why I am obviously not cut out for higher eschelons of management. I have no patience for greed, and most corporations seem to assume that managers will operate out of self interest instead of the good of all. The incentives and initiatives I observed when I was management all were geared to appeal to shortsightedness and personal gain. This current financial mess the world is in is because of this sort of business philosophy and everyone having his/her hand in someone else's backpocket.

I guess I'm done being gripey tonight. Tomorrow is another day! Hey, at least I'm not just droning on about how my head hurts tonight!