One Step Forward, Two Steps Back – My Health Care Story

35d9705ec5344ddc3d9a584fffadc237--manga-eyes-garth-williamsFor the past 1,825+ days, I have had sinus pressure that feels like little slightly obese mice tap dancing across my cheeks accompanied with a sinus headache, congestion, and a runny nose.  It’s there every day when I wake up. It gets progressively worse through the day and is there when I go to bed.  I have called my various doctors too many times to even count begging for relief, participated in countless web diagnostic sessions, and sat in doctor’s waiting rooms and exams rooms for over 24 hours, if not more, if I added all the 15-30 minute appointments up.  I have had at least four CT Scans and gone to four specialists.  I have tried nasal sprays, steroids, nasal rinses, anti-reflux medication, and anti-migraine medicine.  I have tried a lot of antibiotics – SO MANY ANTIBIOTICS!  So many antibiotics that I fear if I were to actually get a serious infection the bacteria would just laugh at me and infection would destroy my entire immune system.  With everything I’ve tried nothing has given me any relief.

I haven’t missed any work because of my sinus infections, sinusitis, and sinus pain; I don’t complain about the pain even when it makes me want to curl up and cry (I don’t complain about the pain because it does absolutely no good and I’ve gotten to the point where the doctors have almost convinced me that I am crazy and the pain I am feeling is not real); and I’ve even run a half marathon with a raging sinus infection.  Because if I let my sinus issues stop my life I would have even less of a life than I already have!

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For the past three years, my health insurance has been through Kaiser Permanente.  I have worked with my general doctor, two ENT specialists, and an allergist in attempt to find a solution to my sinus issues.  After three years, Kaiser has been absolutely inept at diagnosing or providing any effective treatment options for my sinuses and so when we had open enrollment at work this year I decided to switch health insurance providers and changed to Anthem Blue Cross Blue Shield.  I had no idea if it would be better, but I figured at least it would be different and honestly it probably couldn’t get any worse.

On July 2nd, I thought my sinus story was about to change.  My new insurance had kicked in and went to my first appointment at my new ENT doctor. During my appointment with my new doctor he took down my LONG history with sinus issues, did an exam and immediately offered a solution.  Balloon Sinus Dilation.  The doctor thoroughly explained the procedure, possible benefits and complications, and the benefits far outweighed the complications.  I was stoked by the idea of reduced sinus pressure, headaches, congestion…all with a relatively easy procedure and quick recovery.  To have the insurance pre-approve the procedure I needed to have another CT Scan and then the doctor would be able to submit my paperwork to the health insurance for pre-authorization.   I left the doctor with tears of happiness in my eyes.  I thought I was on my way to a solution and for the first time in over five years I was hopeful that there was an end in sight to this sinus pain…I probably should have known better to be so positive when health insurance is involved.

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Balloon Sinus Dilation procedures are relatively new and so my new insurance, Anthem Blue Cross Blue Shield, apparently doesn’t usually approve the procedure on the first request.  You have to wait to be denied and then the doctor sends in an appeal to see if the insurance will approve the appeal.  So, the solution I was so excited about is apparently now a long shot and when I asked my new doctor what my options were if the insurance denies both the original request and the appeal, he said there’s nothing else I can do that I haven’t already tried.  NOTHING ELSE!  This is the last resort.  If the insurance says no I get to look forward to this sinus pressure and pain for the REST OF MY LIFE!  I don’t mean to be over dramatic but that could be a long fucking time.

So where does that leave me?  My fate is in the hand of the person processing my pre-authorization request.  I have read the clinical guidelines used to approve the requests for balloon sinus dilation and meet all the requirements but I still have to sit here and wait to see what the insurance company decides.    Why do the insurance companies get to hold our fate in their hands?

There are so many battles we have to endure in our current health care system.  We jump through hoops to get the right health care coverage and then we continue jumping through hoops, getting lost along the way, until we finally find the right doctor with the right answers and that just seems to be the beginning of the battle.  We can have the best doctor, the best solution to the problem, and the insurance company can still say no.  They simply say they are not paying for a particular treatment and the road dead ends.healthcare

Why don’t we have a say in our own medical futures?  We pay for our health insurance but a stranger who has never met us gets to decide what is best for us.  I know they have to base their decisions on facts, and facts alone, but I wish there was part of the process where we could include a personal statement about how whatever our medical issue is affecting our daily lives and how being approved for the procedure or treatment we are requesting could change our entire lives.  I feel I could write a pretty compelling statement on how this sinus procedure could change my life.  But, instead, I wait…and wait…and wait…and hopefully, after all the waiting I will be closer to a solution.  And if not, there is no going back to the drawing board for me, there’s just accepting that this is what life will be, me and my little slightly obese tap dancing mice.35d9705ec5344ddc3d9a584fffadc237--manga-eyes-garth-williams

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