health update/diatribe/infodump BUT THERE'S A CAT VIDEO AT THE END
Dearest reader: This should be a simple health update, but instead, it's an obnoxiously detailed info-dump written by the kind of person who knows more than most people about American health insurance but is still surprised at how it continues to find new and innovative ways to suck. If this is not the type of thing your brain or nervous system wants to wrap itself around, I don't blame you one bit, but if it is, I hope you'll at least walk away having learned something or being at least mildly entertained. If not, feel free to
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When last we left our third-or-fourth-favorite mildly niche-famous T-list Broadway person, she was finally on the brink of getting a brain and pituitary MRI. This was supposed to happen on Friday.
But I wasn't allowed to get the MRI on Friday because Cigna's pre-authorization was still pending and there was nothing my doctor could do to escalate its urgency, nor could they withdraw the order. They couldn't do anything at all until the third-party organization that approves the pre-authorizations signed off on its medical necessity.
Look, I get it. This is an expensive and labor-intensive procedure, so they have to be thorough. I mean, sure, my doctor said it was medically necessary, and sure, they sent the additional clinical information to confirm its medically necessity, and sure, every order at every stage was marked as urgently medically necessary, and it was sent for processing on Monday, but how can they REALLY be sure it's medically necessary until my case is also reviewed by doctors who have NEVER seen me, and don't work weekends or holidays, and will get around to reviewing it at their own leisure? The folks at the radiology clinic rescheduled me in their next available spot and maintained that they'd contact me as soon as possible to fill any upcoming cancellation spots.
A ridiculous mildly annoying setback was that their next available appointment wasn't until July 26. They couldn't attempt to book me at any of the other dozens of clinics affiliated with this hospital network, because the pre-authorization is site-specific, which is like buying someone a gift card from the Starbucks on my block only to find out that they won't honor it at the Starbucks two blocks down perfectly reasonable, because I'm sure every site has differences that can't be perceived from a patient perspective.
Oh, and the existence of a pending pre-authorization prevented them from doing the MRI that day even if I'd had $8K in cash to pay out of pocket for the procedure. Which is perfectly reasonable, because why shouldn't American healthcare policy punish rich people too? I'm sure it's many flavors of unethical for one doctor to do something without the approval of another doctor even though the doctor whose approval it hangs on has NEVER SEEN ME.
One fellow in particular--I'll call him Quincy--gave me some insider info on how to prepare for the types of advocacy he's had to do in the past with this particular pre-authorization team, and which numbers to call and questions to ask. He isn't technically supposed to know this stuff and also isn't technically supposed to share it, but says he does it all the time anyway--hence why I'm keeping him anonymous. Quincy isn't his real name, but Quincy is a real one, and I took in his information like a medieval warrior selecting the choicest armor to prepare for battle the informed and fully compliant patient I strive to be.
Anyway, a few persistent phone calls later, a Cigna rep informed me that the middlemen would approve the pre-authorization for the MRI on the condition that I get the procedure done at a standalone radiology facility instead of a hospital-affiliated facility. Which is like buying someone a gift card that could only be honored at Starbucks kiosks located inside Target stores, but not at a standalone Starbucks or anywhere else in Target perfectly reasonable, I know the insurance companies don't wanna have to spend hospital prices any more than I do. So I spent a great deal of time yesterday looking up non-hospital-affiliated radiology clinics that were in-network.
I made an appointment with one clinic for Thursday. But I also made an appointment request at a different clinic for Monday morning, just in case they could see me sooner--because I knew this clinic didn't accept Medicare or Medicaid, and were therefore exempt from the requirement of third-party pre-authorization. (Pro-tip: even if you do have Medicare or Medicaid, always try to bypass pre-authorization for diagnostic procedures, especially if you have a particularly high in-network deductible--it's entirely possible that paying out of pocket for a service at an out-of-network provider could cost less than the amount you'd have to pay towards your deductible at at in-network facility. American math.)
THIS MORNING, I woke up at 8am to a phone call from the latter clinic, saying that if I sent them the doctor's prescription, they could pre-authorize the procedure and see me tomorrow. So that's what I did...and then I got an email saying that they couldn't accept a prescription for an MRI with and without contrast because they don't have contrast at that facility. Which is like finally securing a coveted reservation at an elite steakhouse only to find out they don't season their steak or even have steak sauce perfectly reasonable, because not everyone needs contrast, but I do, so that place was out.
But as far as I've been told, Thursday's appointment should go off without a hitch as long as I call EviCore (the pre-authorization middlemen) tomorrow morning to tell them all about the not-hospital that will be giving me a not-hospital-priced MRI, so that they can grant the pre-authorization at long last.
Perhaps if I plead my case and bat my eyes at them real cute-like through the phone, they'll give me some other reason why it's actually not medically necessary for me to know definitively whether or not I have a literal brain tumor I can get seen even sooner than Thursday.
FUNNY STORY THOUGH...
A couple weeks ago I was talking to a friend from church who was going through a lot of the same stuff as I was, and I was like "idk, maybe get your cortisol checked?" and lo and behold, he messaged me back a few days ago saying that he'd found a new doctor and asked him to do just that, and WITHIN A DAY his doctor ordered ALL the labs I'd fought for (serum blood cortisol, low-dose dexamethasone suppression test, 24-hour urine, saliva, etc.) AND an MRI for suspected Cushing's.
And he completed ALL OF THAT within a week.
Although he did have to suffer for quite a while before I floated the possibility of Cushing's, just like my friend Alan had to suffer for years before his own endocrinologists floated the possibility of Cushing's. Still, they both got that MRI the second it WAS floated, without a fight, and I'm genuinely happy for them.
But I can't help wondering how much quicker and easier this whole process would have been for me if I were a man. Or if I was neurotypical. Or if I still had a choice about whether or not to disclose being autistic. But mostly if I were a man.
THIS IS THE END! HERE IS THE HTDIO-ADJACENT CAT VIDEO YOU WERE PROMISED!
I'm fostering my friends' exquisite tuxedo princessfloof for a few weeks. Chevy and Tex are being very accommodating foster siblings, but she's much younger and is used to being the only pet, so naturally it took her a while to acclimate.
But there was one thing she took to immediately: the How to Dance in Ohio fidget spinner.