December 02, 2021

Putting It To Rest


Irony: Filling out a brand new planner, only to have nothing go as planned.

The past couple of days have been, well, kind of a mess. Like I wrote yesterday, I was scheduled for an MRI of my back this morning. When Jerry came in from work, he brought the mail in with him. There was a letter from the insurance company stating that the MRI was "not medically necessary" and they weren't going to cover it unless I met their requirements.

From what I read, I absolutely meet the requirements; I have no idea why they wouldn't agree: 1) My pain has to have been ongoing for more than six weeks (I first started seeing doctors about it in 2017, so I'd say that's more than six weeks) and 2) I had to have tried physical therapy, medications, or other remedies.

Well, I did physical therapy in late 2017 for my neck/back/shoulders. I have tried more medications than I can count, especially since seeing the rheumatologist this year. I was prescribed a TENS unit back in 2017, which I still use sometimes when my neck and shoulders are really bad (I don't think it actually helps, but I can make the jolts from the electrodes strong enough that I concentrate on those instead of the neck/back pain, hahaha). I've also gone to a chiropractor for adjustments (unfortunately, they did not help).

How many more "remedies" do I need to try before they'll approve an MRI?

So anyway, I did not have the MRI today. I can appeal the insurance company's decision, but that will take a while and by then, it'll already be 2022--a brand new year with a brand new deductible to pay. Convenient for them, right? It's kind of disgusting how much money we pay for insurance only to be told that a test I meet the requirements for is "not medically necessary".

After reading the letter from the insurance company, I just kind of lost it. Not in an angry way, but in a defeated way. I cried as I told Jerry how tired I am of all of this. I'm ready to just let it go--I don't have any hope left in me. There are millions of people who live with chronic pain every day; I should just be grateful that I can still move on my own (albeit it very stiffly sometimes!). And I can't even describe how grateful I am to have such an understanding and amazing husband.

I really hate writing about pain because I feel like I'm whining and complaining (and nobody likes hearing people complain). But now that I'm not waiting for test results or to see a new doctor or something like that, I feel like I can put it to rest for the most part (at least here on my blog). I actually didn't even have intentions of writing about this today.

The whole point of my post was supposed to be the irony of planning things only to have nothing go as planned. And that's exactly how the past couple of days have gone. But tomorrow is a new day and I am going to move on :)

19 comments:

  1. Oh no, so sorry to hear this. For my job I work with health care provider groups and their billing department. Your doctors office should absolutely be able to help you write an appeal for this. From everything you are saying you have all the right to have this done. In the appeal, provide approximate dates you had those things done, if you had the same insurance this whole time they will even have records of the previous claims themselves, so even better! If you have the copies of your explanations of benefits from the visits reference them in your appeal. So sorry you are dealing with this. Feel free to message or email me if I can help with any of this. I fight with insurance every day. ๐Ÿ˜€

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  2. I’m sorry to hear you are fighting with your insurance company. Your rheumatologist still has the results from the x-rays, and ordered the MRI’s because she has a theory to investigate. Perhaps she has other ideas to investigate, or can adjust your meds based on her theory.

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  3. Insurance can be SO FRUSTRATING sometimes! (I wish that the "beancounters" would have to live with our illness/pain for 24 hours before they're allowed to deny anything.)

    Please also don't feel like you have to avoid writing about a particular topic. This is your blog and we'll read anything you decide to write. ๐Ÿ’—

    Take care,
    Martine

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  4. It's the time of year I dread, because I hate winter. Yesterday morning it felt like spring here in Iowa, and I decided to grow a set, and take the crazy neighbor dog for a run. His mom uses a walker, and he's a one year old that loves me. but has drug me through the park chasing another dog. I can barely control him. She feels guilty that she can't take him for a walk, but I'm so scared that he'll get away from me, and get hit by a car. His whole life consists of being tied outside on a leash, waiting for some excitment, and I feel guilty like I need to walk him, but the last time I did it, he just laid me out flat on my belly because he's crazy! He knows the sound of my truck, then he gets all crazy and I give him a dog treat while he's jumping on me, I don't know what to do, sorry, I feel bad for him, but she wants me to adopt him, and we just can't go through that again. And we have our rescue dog that's spoiled rotten. Anyway hope you keep running because you inspire all of us.

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    Replies
    1. This lady is doing this dog no favors and in fact is harming him. She needs to give him up to a better home. Why do people have animals they can't care for? You have a good heart. I would feel heartbroken for this animal too. God bless.

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  5. Hi Katie - your Dr should have gotten a similar letter from your insurance company and can also appeal. Usually the Dr appeal goes much faster and since it's the beginning of December, you may still be able to get it this year. Also, check to see what the cash-pay price is (both at that place and some smaller radiology companies) - sometimes it's much more affordable than I anticipated!
    -J

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  6. Katie, Tomorrow certainly is a new day and I do encourage you to appeal the insurance company's decision - and as part of that appeal request reimbursement of any future co-pay if the decision is overturned. I hate that you are going through this and truly hope this new day will give you renewed focus on trying to get relief. Wishing you the best!

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  7. Ugh. I'm so sorry. This is so frustrating!! I won't go down my conspiracy theory "insurance companies are ruining everything" rabbit hole, but I bet you understand. And I will offer one more thing you might not have tried: Egoscue Method. Pete just put out an updated version of Pain Free. It is the slowest, not-overnight-in-the-least, long-term fix ever, but it has worked for me. I'll continue to keep you in my thoughts.

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  8. The healthcare system in this country is a joke. I could rant about it for hours but I'll spare you lol. I am so sorry to hear about this, I really hope you do the appeal and that it'll work out for you! You gotta vent and get your feelings out though! You are not a complainer, these are your real feelings and they're valid! Wishing you the best Katie, things will get better! <3

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  9. You should be grateful that Jerry has a job where you are provided with health insurance, also probably vision and dental. We are both self-employed, and therefore buy insurance on the Marketplace to the tune of $1,100. per month. It covers a physical, colonoscopy and most of my lab work once a year. Everything else I pay out of my pocket, up to my $6,400. deductible. Including my husband's glasses which change every year as we age, to the tune of $500. I have several chronic conditions, including IBS, high BP, GERD and severe anxiety. My insurance pays ZERO for mental health. So I get up and go about my day like everyone else, and when working I am so busy I don't have time to think about it. And I certainly don't have time for whining and complaining.

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    Replies
    1. Jesus Christ stop reading this blog then. You know what I hate: people that complain about what people write on their own damn blog. And you say you don't have time to whine and complain about your insurance yet here you are on the internet, whining and complaining to strangers. Hmm. No one wants to hear it, bye.

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    2. Lol Amanda love your reply! ๐Ÿ‘

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  10. Oh no! I too had to appeal several procedures. Call both your doctor and the insurance company and ask for a peer to peer review- this is where your doctor talks to the doctor at the insurance company. It's extremely time consuming and frustrating. I learned I had to take control, my husband was so helpful so that helped a lot. I know Jerry will help you get through this.

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  11. As everyone has said, file the appeal. Insurance is incredibly frustrating to fight with and they fight you on the dumbest things. My SIL and MIL both live with chronic pain and I know how much they hurt and how hard it is, because no one really understands their pain. If you haven't lived with it, you just don't know. I hope that you can get some answers and a treatment plan that will work soon. Hang in there and don't lose hope. Don't let the jerk above me discourage you from writing about your experiences. I have been a long time reader and you never come off as whiny, this is YOUR blog about YOUR life. If you are dealing with chronic pain, absolutely share it with us. Sometimes just sharing the burden with others helps. Love and light.

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  12. Appeal. Pain is no joke & you certainly have every right to be mad. We pay a bit for insurance & it ticks me off it doesn't cover certain tests or visits. Some diseases/diagnosis take time to determine.

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  13. I feel very deeply for you. I’m 38 years old and used to deal with chronic pain from psoriatic arthritis. It’s a type of awful that you can’t explain - and worse yet - you can’t see. So while you look fine on the outside to everyone, you can barely function on the inside. If by chance you get diagnosed with an autoimmune disease like rheumatoid or psoriatic arthritis, read The New Arthritis Breakthrough. It seriously changed my life. Of all places I came across it on a YouTube comment lol but going on minocycline was a miracle. The problem? Very hard to get a doctor to prescribe - the new drugs are waaaaaay more expensive.

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  14. I feel ya, health can be so frustrating! I don't deal with chronic pain, but have been dealing with chronic fatigue for at least 2 years now. No answers yet, although I did have an inflammation test that was really high, which my doctor just kind of waved off. I just want to be able to get things done and not be exhausted every day. I hope you can appeal your insurance! They really can be dumb. I had gallbladder removal surgery a few years ago and they denied my pain medication when I got out because it was Oxy. I mean I get it with opioid addiction, but I literally had never had pain medications ever before and it was 5 days worth of meds after surgery. Best of luck! I will be sending you good vibes.

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