Thursday, August 6, 2009

I just want the MRI dammit! (now updated with more rant!)

I am fond of health insurance. It's covered the birth of my kids, their visits for broken bones, well-child check-ups and the like. Usually, it works in my favor. Right now though, my health insurance company is on my shit list and I'm going to vent about it.

I'm still on Percocet every three hours and a muscle relaxant four times a day for the pain in my neck and arm. I am still in pain. My doctor (who is a DO and can do all that fun stuff a chiropractor does) cannot get my back or neck to snap-crackle-pop into place. He fears hurting me even more by trying and wants the MRI to confirm his thoughts that I have a herniated disc. Last week he approached Harvard Pilgrim, my then-health insurance company, who denied the coverage essentially because we were changing insurance companies on Friday. Ok, I get that denial. Granted, it sucked, but I figured that once I got my new health insurance in place we'd be set. I couldn't be more wrong.

My new insurer (that would be Anthem Blue Cross Blue shield folks) has denied the MRI as well. Apparently they would rather I stay hopped up on drugs all day, not fully able to care for my kids, until maybe the pain just disappears, intead of finding out what is truly wrong with my body. I can't drive, as each of the drugs alone make me dizzy and tired and when taken together make me a woozy mess, so I haven't been out of the house unless accompanied by another adult, for over a week. My doctor isn't 100% certain that I have a herniated disc; it's just a suspicion that he needs the MRI to CONFIRM. I don't want to stay hopped up on drugs. I want to feel better. I want to do what needs to be done to feel better, but if we aren't exactly sure what is wrong, I can't do that. I want to sleep through the night without being awakened by pain and the need for more drugs. I want to be able to put my twins into their cribs without shooting pains in my shoulder. I just want to be whole again.

I know that my situation isn't different from many other people in the US who are continually denied coverage by their insurance companies. It just makes absolutely no sense to me why this needs to happen, why doctors aren't able to get requested services for their patients. Insurance companies need to rely on the expertise of the doctors, not on their bottom line. We pay for this insurance every month out of our paycheck and we deserve the coverage we're entitled to. Get it together insurance companies (that means YOU Anthem) and get people the care they need. I just want the MRI dammit!

Update: Not long after I hit "publish" my doctor himself called me to say that I got the approval from Anthem. He said that they told him that of course they couldn't deny the request (so WTF why did they?) and then proceeded to give him the runaround about giving him the authorization number. The MRI got scheduled for tomorrow night. The MRI place called me to ask a zillion questions and confirm my insurance, whereupon we determined that my doctor somehow got the approval from Harvard Pilgrim, not Anthem. I called the doctor's office back to say um, WTF I don't have Harvard Pilgrim anymore, that was the whole problem last week, how is it possible that they would approve a cervical spine MRI if I don't have COVERAGE with them anymore? So here is what it boils down to: Harvard Pilgrim DENIED me coverage last week because my insurance was going to expire with them, then APPROVED me coverage after I was with another company. My head is spinning, and not from the drugs. Holy crap what a country.

7 comments:

creative kerfuffle said...

i really, really have never understood insurance companies. they make an ass load of money on the premiums we pay. if a doctor says you need xyz test or xyz medicine an insurance company shouldn't be able to say no. i hate our health care system, though, granted, i don't have the solution. i hope you get some relief and SOON!

Kellie said...

Damn. That SUCKS!!!

I hope you can the MRI and get some relief real soon.

Aunt Becky said...

I'm so sorry. Insurance companies are a huge pain in the butt.

~Jennifer~ said...

Yup. Insurance companies never mind taking your money, but heaven forbid they have to pay for something you actually need.

How you get this all straightened out soon!

Robyn said...

I hear you. I feel you. Don't EVEN get me started.

I just wish you could start feeling better!!!

Astarte said...

Blue Cross is a BITCH about MRIs. I had two done a few years ago when I was having a lot of migraines and losing vision when I had them, to rule out a BRAIN TUMOR, for chrissakes, and months later, the day we got back from vacation, there were two denial letters waiting for us, in addition to a bill for almost $3000. I called them and went around and around with this woman who said that we hadn't followed the 'process', but it wasn't until I started to cry on the phone that she softened a little and told me to submit a rebuttal. DH went into work the next day and told them what had happened, and that the policy had changed without anyone knowing it, and thankfully the HR department got on it and fixed the problem within a week or so. Still, though, they would rather me have a brain tumor than allow me to use my premiums to figure out what was wrong with me. I know a lot of people are worried about national health care, but frankly, I can't see how it could get worse.

Mark said...

Well I am new to the world of health care. I have been healthy my whole life, faithfully paying my premiums. One day I woke up with vertigo, vomiting, and my doctor noticed the left side of my face is drooping. These are classic stroke signs (or a possible brain toomer). My doctor suggested an MRA TODAY. Well United Healthcare apparently didn't like that idea. My doctor argued, but now its 9:30pm and I apparently will not get my MRA today. My doc says if they continue to argue, he will cancel and settle for an MRI even though it is not as detailed because he wants to do this sooner rather than later. If an otherwise healthy person cannot get an MRA when he is vomiting with vertigo and the left side of his face is drooping when do these scans ever get approved... Just needed to vent. Thanks for you post, I know now I am not the only one going through this.