Finally got diagnosis, but insurance denies...

[SLadylani]

My probono chiropractor who's also a family practitioner conquers with my diagnosis and ordered the confirming test, a MRI with contrast. Problem: my damn insurance won't cover the test. So no doctors will give me appropriate treatment and pain control until I have a diagnosis confirmed, but I can;t get one.

My PCP refused to see me last time, as you read in my last post, so I'm in the process of being transferred to another, but there's a wait list. Therefore, I can't see a neurologist who could treat me appropriately because they all need referrals. I have no money, the test is $3500. I got denied for disability and SSI because I dont' have a diagnosis. I hate the healthcare system.

I reached my breaking point with pain today and went again to the ER and broke down into tears when the triage nurse asked if I was there for more drugs and that I couldn't be seen because pain wasn't an emergency. I begged to dfiffer then she tried to put me on a 51/.50 and label me as suicidal. When I tried to correct her she said she'd had enough with me and to "get out," and she'd have another nurse see me.

I finally got admitted and actually got an understanding doctor who was willing to treat my pain. But I guess I had let my pain get so severe that Dilaudid iv push did nothing! I asked for nerve medication or a muscle relaxer but they said they didn't do that in the ER. All I wanted was an hour relief from pain, just to give me a break from this, then I cxould go back to my daily life of Tiger's balm and meds that don't work and cpnstant battles and persistence and pain. But I didn't get what I had hoped for.

I left with pain, mind you they gave me valium, which calmed me down enough to relax my muscles which helped. He wrote me a script for a stronger pain reliever and muscle relaxer but only gave me 6 pills! That won't even last until my first appointment! How am I supposed to do this?? I am majoring in pain relief/comfort care and I can't even get it myself. Oh, and I think I might be approaching another bowel obstruction.

Last thing the chiropractor did Xrays on my low back today which revealed it was completelt twisted around and slanted to one side. Explains my pain. I am just so tired, I've used all respources, MS society and all, and feel like I've reached my breaking point and can't go on anymore. I just wanted an hour of relief, but I couldn't even get that.

Support and courage/strength/wisdom please!!

Sara

[deadgamegrrl]

I'm so glad you got an MRI scheduled.  Please keep us updated on what is happening!  And if you want backup on Dateline, i am SOOOO there!  :-)

~~ dgg

[SLadylani]

Thank you all for your support and feedback! Well, my mom is selling things now to pay for my medical treatment, lol. I scheduled the MRI for Monday, it was cheaper than I thought, less than $1000, and a follow up neurologist appointment, $300, right afterward (mind you he did not require a referral to see me, so I am unsure if he is even a legal doctor or a quack or not-I called every neurologist in town and he was the only one who would take me).

In the past 2 days I was labeled as a drug addict by both urgent care and the ER, even though I was asking for non-narcotic pain medications like topical lidocaine!! My probono chiropractor did an xray of my low back, which showed I will basically need spinal surgery the injury is so severe.

And now, Medi-Cal, one by one, is denying each prescription they have been covering for years (I think they're seeing how expensive I am, lol). I'm starting to think this whole thing would be cheaper and easier if I just pain the monthly >$1,000 payment for an HMO as Medi-Cal is doing everything it can to prevent me from living a normal life.

I swear you guys, one day, when I get better, I will finish getting my Masters in Nurse Practitioning and will fight against these kind of things happening. Unfortuneately, it seems you have to have a title or a large amount of money behind your name to get anywhere these days. And who knows, if this gets bad enough, maybe I'll take it to Dateline, lol

Much love, Sara

[geminigirl1963]

You hit the nail on the head deadgamegrrl about the people "in charge"!!!  And it's not just with healthcare!!

SLadylani - Hang in there - I know it's frustrating when you're dealing with ANY government, and especially so when you're in pain and need to be seen by a doctor or have tests done.  It's amazing to me how these insurance companies can override what our doctors, who know us and our bodies much better than the insurance gurus, think we need or should have.  What makes them think they have the right to play God with our lives?  Frustrates the heck out of me!!

Please keep us posted on how you're doing and what you're able to find out.

[deadgamegrrl]

Hi!

I don't really have any suggestions other than the good ones already offered, I just wanted to offer my support.  I am self'-employed and pay a ton of money for a policy w/a 5K deductible.  So most times I end up having to skip the expensive tests as they would be out of pocket anyway with that ridiculous deductible.  I do have decent prescription coverage in theory, but they usually deny anything prescribed that might actually work!

I hate our health care too.  You can bet that the people in charge of 'health reform' have great policies, pay a small portion if any of the premium, and wouldn't last a week in the real world with the rest of us .

So hang in there - you will be in my thoughts!

[Trelau]

I just wanted you to know I'm standing right beside you and I'm keeping you in my prayers.

hang in there k?

[SLadylani]

thanks for the very good suggestions! it's just so hard working with medi-cal as they make you jump through all these hoops and i'm so tired of it all and don't think i can fight much longer. i'm just praying for a miracle at this point, lol. i'm looking into probono options and contacted the nms society for suggestions.

thank you so much, again, for the support, you don't know how much i appreciate your feedback

sara

[geminigirl1963]

I'm sorry to hear you've been having such a rough time.  While I don't think ER visits is the way to control chronic pain, I can understand why you've had to go - and I'm sorry that you've run into some not so nice doctors and nurses there.  I do understand, however, why they only prescribe you a very small amount of medication when you do have to go, even though it's not enough to hold you until your appointment time.  They are for "emergency" or "urgent" control of the problem and not for "continued" control or care - therefore their hands are tied as far as being able to prescribe more long term pain control meds.

I have a couple of suggestions of things you may want to try and of course, i don't know if you have already tried any of them, so if you have, I apologize for suggesting something you have already done.

Have you or your doctor talked to your insurance company to ask for an appeal of the denied test request?  Sometimes if you talk with the insurance company, and can show them proof of all the other tests/treatments that have been tried, and your doctor will provide them with written documentationi showing that this next test is THE diagnosing test that will show whether your not you have the condition that he thinks you do, they will approve it, based on what has already been done and your doctor's notes saying this is the only way he can diagnose you properly.  I'm not saying that this WOULD work, but it may - it would at least be worth a phone call and perhaps a follow-up letter.

Another thing you may want to consider - again, I'm not sure if you have already done so or if it's available where you live - check wtih your local social services department about state medical coverage.  If you're unable to work and therefore, have no income or limited income, they may be able to help you with medical coverage.  Be sure to tell them that you have applied for disability and SSI, but without the diagnosis, you've been denied.  And without the test, you can't get the diagnosis.  They may be able to give you some sort of medical coverage, at least temporarily.

I wish you the best of luck and please keep us posted on how you're doing.