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| Our Fabulous Northern Redbud is in Full Bloom |
I keep putting off this blog post, waiting until I have some sort of resolution, a proper ending, if you will. But here we are, 2 months after this all started, and there’s no end in sight, or no definite end anyway.
So I’ll start this, and maybe post it, and probably write another one once I get a shot and know what kind of outcome, if any, I have from that.
The last time I wrote about my leg in this blog was February 28th while we were in California. This was all very new then. It still feels new, and a little endless to be honest.
When we got back from California I went to see my PT person, Casey. Casey was concerned. She said 30% of people with my condition improve with PT, 30% it makes no difference, and 30% get worse. So she was very cautious. She tried some things, and gave me some simple exercises, but she said that I needed an MRI, and I needed to see a pain and spine specialist.
So I had my doctor order an MRI. We put in a request for authorization with my insurance company. I have a Medicare Advantage Plan through Medica, a nonprofit here in Minnesota. Up until this year we had our insurance through Ucare, another nonprofit, but they dropped their Advantage Plan coverage and sent 150,000 people in Minnesota scrambling for coverage. We actually used a broker because it was so confusing. Medica picked up a lot of Ucare’s customers and we hoped they would be as good as Ucare had been.
After we returned from California I wasted no time acquiring things to make it easier to function, including a cane and a bath chair. I struggled to manage both my meds and my pain. Nothing I took really made a dent in the pain. It was very bad in the morning, and gradually eased during the day, although if I tried to walk too much it came back with a vengeance. This hasn’t changed that much; I think I have just learned to manage it better.
It wasn’t too long before I found out that insurance had denied the MRI, saying I needed 6 weeks of PT with no improvement first. Of course this was at complete cross-purposes with what Casey recommended, but we started going through the motions at least. I made an appointment with a spine specialist and hoped that maybe they could help get an MRI approved.
I requested that my doctor appeal the MRI decision. I went to Summit Orthopedics and they agreed with the original diagnosis but needed an MRI to go further. I requested that they also put in an order for an MRI.
This is where things got interesting, in a terrible sort of way. On Friday, March 13th, I had a conversation with one of my doctor’s nurses. She suggested that I get an MRI and didn’t seem to know that the MRI had been denied or that I had requested an appeal. On Tuesday, March 17th, I talked to someone at Medica that said they could see the appeal. This turned out to be false; I don’t know what she saw, probably the original denial. I tried to call my doctor and see what was going on with the appeal.
Around this time I also acquired my awesome walker. It’s a cheap Rollater off of Amazon, which means it has 4 big wheels that can turn 360 degrees so that gives it a lot of maneuverability. It really helps me get around, and I can manage it by myself, unlike the wheelchair.
On Friday, March 20th ,after many many phone calls I finally found out what happened with the order from Summit that was sent to Ridgeview on Wednesday, March 18th. Ridgeview did not submit it to Medica because of the denial of the previous order. You can’t submit a new request for authorization when there is already a denial for the same procedure in the system. You have to get the denial resolved first. Somehow most of the people I talked to either didn’t know or didn’t understand this rule.
On Tuesday, March 24th, I spent an hour on the phone with Medica. I talked to a very nice, persistent person named Aaliah. I was asking about the status of the appeal. There was NO appeal in their system!!! Don’t know what happened. Aaliah helped me file a verbal appeal over the phone at 9:30 AM that day, but in order to make it a rapid appeal we’d need Dr. Kennedy to do that. Aaliah also filed a grievance on my behalf, because the original appeal appearsedto have been lost. I called Dr Kennedy’s office and left a message and asked for it to be tagged as urgent.
On Wednesday, March 25th, I called Ridgeview, since no one ever called me back. Apparently the message from the day before was not marked urgent after all. WHAT THE ACTUAL FUCK. The person on the phone changed the message to urgent but Dr. Kennedy wasn’t in on Wednesdays. I did go ahead at Lee’s urging and sent a message in MyChart as well. At this point the whole situation sucked.
On Thursday, March 26th, I called Ridgeview again around 9:45 AM. I talked to someone named Merid at the nurses station. She said she would hand-walk a high priority message to Dr. Kennedy’s nurse to give me a call about filing a rapid appeal for an MRI. I said to her, “and when should I expect a call?” and she said “good question”. At least she was honest.
At around 1:45 PM I called Ridgeview AGAIN. I was pretty pissed. They wanted me to leave a message with the Managed Care Team but I said no, I’m not leaving a message with someone, no one calls me back. YOU take a message to them!
Then at around 3:30 PM Dr Kennedy’s nurse called me. He was very apologetic, said the ball had been dropped (duh), told me that the info had been sent to the Managed Care Team, gave me a contact there. THEN the supervisor for the Managed Care Team called me. They filed a rapid appeal with Medica. Finally. They said it would take around 72 hours, so at that time I figured I would hear something early next week. I was relieved and still apprehensive. So many things had gone wrong by this point. This should NOT have been this hard!!
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| Little Grape Hyacinths |
On Monday, March 31st I called Medica. I figured I would know the results of the rapid appeal by the end of the day but I wanted to make SURE it was really in their system. I did not trust my doctor’s office at all any more. Although it took close to 30 minutes just to get transferred to the right department I finally did. He looked it up, he found the appeal and said, “it’s been approved.” It was all I could do not to burst into tears right then. But I (sort of) calmly asked, what is the next step, can I go ahead and schedule the MRI? And he said yes.
So I called Ridgeview Imaging and told them I wanted their earliest possible appointment. I was able to get one for the very next day!
Then I went to my scheduled appointment with Casey. Really we mostly talked. She tried a little bit of stuff but that morning the pain was really bad so even trying something that helped a few weeks ago made no difference that day. She told me what to expect after the MRI depending on what they see. That’s good to know.
So I had the MRI, and then I had the consult at Summit on Tuesday, April 7th. We went over the MRI together. I’ve got nerve compression and spinal stenosis at L2, L3 and L4. I was scheduled for a cortisone shot on April 20th and then a surgery consult 2 weeks after that. But most of you know what happened then…
Sarah had strep, and so did Emi, and I had had a sore throat for a couple of days. I kept trying to ignore it but finally went to Urgent Care and got a test. It was positive, I went on antibiotics. End of story? No. When they called for my pre-shot health check I found out that now I couldn’t have the shot until at least 2 days after I finished the course of antibiotics.
So now the shot is scheduled for May 1st.
Of course this isn’t the end, but what will the end look like? Will the shot work? Will it work for a day, a week, a month, 3 months, forever? I don’t know. Will I eventually have to think about surgery? Will the surgery work? So many questions.
In the meantime it’s beautiful early spring in Minnesota. Our yard looks great, and thank goodness for Sara our gardener, otherwise we would have a big problem. I try to get out and about as much as possible without overdoing it.
As I look back on the notes I’ve kept I know I’m better. It’s so incremental that it’s hard to tell but over a couple of months I’ve definitely improved. I get sad sometimes, I wish I could at least go for a walk and ride my bike but oh well.
Soon enough time will do its work and I’ll have more to add to this saga. I’ve certainly learned more about the working of insurance than I ever really wanted to know! Before I get the cortisone shot I need to educate myself a little about the workings of my spine. Professionals start spewing out all these terms, L3, L4, compression, spinal stenosis, and I only have a vague idea what they’re talking about. Before they stick a needle in me I need to become more knowledgeable about this area of my body!
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| Sophie is Unfazed by it all |
