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People Suck

People suck! The last two weeks of love had been dominated by fighting with Cigna over coverage and prior with denials. I have to say that I think Dr. Chirag Shah, Dr. Karen Weinstein, and Alexis R from Cigna were at the top of my list of people who suck untimely yesterday (more on that later.) The two doctors are medical directors at Cigna or Evernorth (a Cigna subsidiary) whose job is to review and deny prior authorizations. Given the speed with which my requests were denied, I’m skeptical that they reviewed the records.

Cigna uses PXDX, a computer program, to deny claims in seconds. The doctor signs off on the computer program’s decision without the patient’s record being reviewed. At this time, Cigna is fighting two separate class action lawsuits for denying claims without proper review. One based in California arose from a patient whose vitamin D lab test was denied coverage despite a diagnosed deficiency. Funny enough, they denied my vitamin D lab tests three times last year despite the diagnosis being on my records from three different doctors. I will also be fighting to have those expenses reimbursed.

Back to people suck. The person that sucks the most this week is Sidney from Jackson, MS. She was kind enough to avail herself of my credit card to purchase nearly $750 in goodies. Unfortunately, Sidney is not the brightest bulb on the tree. She updated all of her contact information on the file before changing the email address, so I have her home address and phone number. Dear lord the area between her ears is as empty as a liminal space.

Fortunately, my credit card company shut down and blocked the orders immediately. Nonetheless, I was still on the phone for twenty minutes making sure the account was now secured. The representative I spoke with was wonderful and professional. She took care of everything expeditiously. Of course, the dilemma now is to if I should file a police report. Kohl’s canceled the order immediately, so there are no monetary damages. Yet Sidney from Jackson, MS still committed fraud. I’m not sure I’m willing to waste my time. Anyway, people suck and I hope I never see any of these folks in a crowd or otherwise.

Who was your most influential teacher? Why?

I had so many incredible teachers over the years, but one stands out. If you had told me the first day I sat in this class that this teacher would change my life, I would have laughed at you. The grade was tenth, the class was speech and the teacher was Mr. Quinlan. In that class, he saw something in me and invited me to join the speech team. At first, I was reticent to join, but ultimately decided it would look good on college applications so I joined.

I joined the team to compete in the extemporaneous speaking category. In this category, speakers had to draw three questions and then pick which one they were going to give a speech on in 30 minutes. It was baptism by fire, but it gave me the ability to speak confidently in front of rooms of people as well as synthesize information quickly and succinctly. These skills have served me well as an adult and I’m forever grateful to Q for that gift.

Taking a Break

I’m taking a break from the rabbit hole that is Cigna and health insurance in this country. The truth of the matter is both Presidential candidates happily took money from Cigna for their campaigns. This means both potential Presidents will allow Cigna to continue defrauding Medicare while abusing its insured. Shoot even the anti-business Bernie Sanders has no problem taking money from big business. The billionaire politicians, along with the insurance companies bear responsibility for the clusterfuck that is our healthcare.

Anyway, so much for taking a break. Am I right?!? Goalielocks is home for spring break and that makes my mamma’s heart so happy. If Jake was here, life (even with Cigna in it) would be perfect. I’m privileged to have three amazing boys and two perfect puppies. As I take a break from the insanity, I’m trying to focus on the bright side of life. I also had to grocery shop for the third time this week. With both younger boys home, the amount of food and milk we go through grows exponentially. Fortunately, I have the best Shipt shopper in Eric who always takes good care of us.

What do you wish you could do more every day?

I wish I had more time to exercise during the day. Moreover, I’d love more time to sleep, read, and play with my puppies. Of course, I can’t forget baking. I’d love a lot of additional time to bake.

Rabbit Hole

I went down the X rabbit hole last night reading posts on Cigna, pharmacy benefit managers, and health insurance in general. The fact that the Federal government allows these companies to operate unchecked, even after being caught defrauding the Federal Government, is appalling. It’s unbelievable the number of people who pay for insurance that find themselves fighting to get care. It’s morally and ethically wrong.

In the ongoing saga of prior authorization hell, they did ultimately approve my hubby’s knee MRI. Alexis R, from Cigna, emailed me yesterday stating, “The mayor’s medication, cephalexin, is considered a non-preferred covered medicine. This would require prior authorization and we have not received it at this time.” According to her email today, the problem wasn’t the Cephalexin itself, but the dosage. These folks can’t even get their facts straight.

This whole thing feels like a plot out of a bad sitcom only nobody is laughing. The fact of the matter is delaying care leads to poor healthcare outcomes. Ultimately, the poor outcomes lead to greater expense and death. Dealing with these issues is not an anodyne experience. Dealing with insurance companies is quite a pernicious ordeal.

What tattoo do you want and where would you put it?

I’m not into tattoos or putting anything permanently on my body. For one, I seem to be allergic to absolutely everything. Two, I don’t know where I’d put it. Three, it’s not something I’d ever spend money on. If I had to do it, I would tattoo my kids’ initials on a heart or something on my ankle. Anyway, I have to get back to my rabbit hole.

Dog Food

Last night, while the hubby was grilling up some of his famous potatoes and steaks, I made dog food for the puppies. I bought a duck breast at Wild Fork a few months ago and defrosted yesterday. Obviously, it’s not something I’ll do all the time, but thought it might be a nice change of pace for the boys.

For their meal, I peeled 3 carrots, cooked 3 cups of rice, bought 1 large duck breast, and hard-boiled seven eggs. Note, I did not use all the eggs for their food. Veterinarians recommend that dogs have no more than one egg per day. To cook the duck, I lined a baking sheet with aluminum foil after preheating the oven to 350 degrees. I placed the peeled carrots on the baking sheet with the duck breast in the middle. The meat and carrots roasted for 20 minutes. Once the duck breast reached an internal temperature of 165, I cut it up into cubes and cut up the carrots.

Once the duck and carrots were cut up, I added them to the cooked rice and mixed them well. Naturally, I poured any of the juices from the duck into the mixture. The last step was to cut up the eggs and add them to the mixture. Ideally, I’d use more vegetables, but I only had carrots on hand. Next time, I’ll use sweet potatoes and peas in addition to the carrots. The recipe is below.

Homemade Dog Food

Ingredients:

  • 2 Duck breast/chicken breast/chicken livers
  • 4 carrots
  • 3 cups of rice
  • 1 egg for each dog per day
  • 1 sweet potato
  • 1 package of frozen peas

Instructions

  • Cook rice according to package instructions
  • Prepare a baking sheet with foil and preheat oven to 350 degrees
  • Wash produce
  • Peel and cut carrots in half and place on the prepared baking sheet
  • Cut sweet potato into cubes and place on prepared baking sheet
  • Place duck breasts or desired protein in the middle of the baking sheet
  • Roast the duck and vegetables for 20 minutes or until the internal temperature of the duck is 165.
  • While the duck is roasting, cook up the peas according to package instructions and prepare the hard-boiled eggs
  • Once the duck and vegetables have cooled, slice the meat into chunks and the carrots into smaller pieces.
  • Combine all ingredients in one large bowl and serve

I have two large (80-90 lbs) male dogs and split the recipe between the two of them. Going forward, I’ll probably use chicken as it’s much cheaper, but the duck is a nice treat. You could also substitute lamb or beef cuts as well.

What is one word that describes you?

Kind. I love people, animals, and life and want to make the world a better place. Fortunately, I think little acts of kindness go a long way in brightening the world. Consequently, every day I try to be kind to those around me (some days go better than others,)

Rage Baking

Yesterday after receiving yet another prior authorization denial, I started rage baking. I figured it was a healthier way to deal with the anger than sitting and ruminating on it. The first thing I baked was sourdough cinnamon and sugar toast cereal. Now Cinnamon Toast Crunch was my favorite cereal growing up, so I had to try it. The recipe was simple and it tasted so good. It’s something I’ll make again.

The next bake was a fast no-knead bread that would pair perfectly with the Osso Bucco the Hubby was making. The second rise was a little suspect, but the bread still cooked up nicely. While I proved the no-knead bread, for three hours, I whipped up some sandwich bread. By the time, the sandwich bread came out of the oven, the no-knead bread was ready for the oven. Both turned out well. The sandwich bread is a bit shorter than I’d like, but I’m not sure if it was the pan size or something with the dough. Fortunately, it tastes really good.

Now back to the issue of prior authorizations. They exist to prevent fraud, reduce costs, and eliminate unnecessary costs. While Cigna would be quick to sue you or put you in jail for insurance fraud, they had no qualms over scamming the Federal Government to increase Medicare payments. That’s right while Cigna gatekeepers and actively denies coverage to paying members, it’s been defrauding the Federal government. And yet our government continues to allow them to have a seat at the gravy train that is Medicare.

In fact, they had a home visit program solely designed to upcharge Medicare. They settled a lawsuit with the federal Government in September to the tune of $37 million. In a separate lawsuit, also settled in September of 2023, Cigna will have to pay the Federal Government $172 million. Cigna, according to the allegations in the suit, employed medical coders to review Medicare patient’s charges and add diagnoses that would be supported by the information therein. Essentially, they were diagnosing their insureds with as many conditions as possible to increase their reimbursement from the Federal Government.

I find it hysterical that Cigna got busted for adding fake diagnoses to bolster their Medicare payments while denying claims for folks with actual diagnoses. They like to have both ways. They’ll diagnose you, and take the reimbursement money, but they’re not going to approve your claims. It’s criminal.

What was the best compliment you’ve received?

The best compliment I’ve ever received was when my son told me I did a great job as a mom and that he’ll always take care of me.

Another Day

Another day, another prior authorization denial. Boy, Cigna is outdoing itself this year. In the four years we’ve had Cigna for our health insurance, we have had no treatments that required prior authorizations. Suddenly this year, Cigna has lost their ever-loving mine and we’re already at our fourth request for prior authorization. It’s asinine.

Obviously, the most egregious example is their request for prior authorization on the Mayor’s prescription for antibiotics. In the last seven days, I’ve had prior authorization/coverage denied for a medication I’ve used for over two years. I guess after two years of proven efficacy is insufficient evidence for Cigna. Ironically, the first doctor that denied the prescription is a palliative/hospice doctor. I’m sure denying coverage for key therapies only improves his business being a bridge to death.

To say I’m at my breaking point with this situation is an absolute understatement. Fortunately, I’m a persistent person who will not give up until this issue is fixed. I fully intend to be a thorn in the side of Cigna and their prior authorization denial “doctors.” I use the term “doctors” loosely as these folks have abandoned their commitment to the Hippocratic oath, medical ethics, and patient care. They should be embarrassed, but I’m sure they’re not because they’re well-paid to deny coverage. Another day, another afternoon of rage baking, which includes Cinnamon Toast Crunch, Fast no knead bread, and sandwich bread.

You’re going on a cross-country trip. Airplane, train, bus, car, or bike?

I’m defiantly taking an airplane cross-country. Once I’m to my destination, depending on where it is, I’m taking a car. Case in point, my trip through the Mighty Five last fall.

Prior Auth

The fact that the prior auth process exists underlines just how screwed up our healthcare system is in this country. Since the year started, we have had three prior auth issues with our insurer. The first was a prior auth for an MRI on Hubby’s knee to verify the extent of damage. The second was their denial of a prior auth request for a medication I’ve been taking since 2021. They denied it so quickly that I received a notification of the denial before receiving the notification that the authorization was filed. Lastly, they requested prior auth for the Mayor’s antibiotics to fight his post-surgical infection.

Now read that last sentence again. They now require prior authorization for antibiotics. Admittedly, I am not a doctor, however, I’m pretty sure that infections are supposed to be treated expeditiously. As a result, we ended up having to pay for the medication out of pocket. The doctor’s office couldn’t believe the insurance requested prior authorization for an antibiotic. This is an absolute abomination. Insurance companies shouldn’t be requiring prior auths for well-known first-line treatments.

Cigna, to their credit, did respond when I tweeted my disgust to them, Governor Desantis, Senator Rubio, and Representative Frankel. Nonetheless, it’s too little too late. I will be requesting reimbursement from their customer care team. I aim to ensure that we rein in this prior authorization nonsense here in Florida.. It is, however, a national issue. Fortunately, I work in insurance, so I can navigate the mind field pretty well. I can’t imagine how difficult the experience would be for people not familiar with insurance.

What activities do you lose yourself in?

I lose myself in baking, running, cuddling with the puppies, and reading. Those activities are my happy place. I love losing myself in a good book. Perhaps that’s why my night time ritual includes reading a book before bed with Anakin on my lap.

Update to the Update

Well, here’s our update to the update on the Mayor’s finger. It continues to heal, albeit slowly like a snail. He is finally out of a splint much to his relief. Unfortunately, his finger looked pretty angry and red this morning, so they’re concerned it may be infected. Consequently, the Mayor is starting a course of antibiotics today. Hopefully, those will take care of the infection.

The bigger issue in our update is that he hasn’t been diligently working the joint. It is quite painful for him to move it, but he’s got to start working on it. As the PA was moving it this morning, you could see he was in a lot of pain. This is problematic because it will cause a permanently stiff joint in that finger. As a result, he’ll need a lot of OT to get the top joint of the finger moving again.

What movies or TV series have you watched more than 5 times?

I think I’ll answer this with memes from each of the shows. We have a few favorite shows in this house. The Office was the background to our lives for most of the 2010s. It then became Family Guy or for me, It’s Always Sunny in Philadelphia. My morning routine always includes my Dunkin’ coffee and the Great British Bakeoff. Additionally, when I run on the treadmill I watch Curb Your Enthusiasm. Larry David makes me laugh and helps me get through my runs.

Superstitious

Am I, a hockey player and hockey mom, superstitious? Hells yeah. We hockey folks are extremely superstitious. It’s a crucial part of the experience. For example, one simply does not mention the word shutout until the horn has sound. Inevitably, if those words are mentioned before the game has ended, the other team will score. Do not be the guy that kills the shutout. Also, if the team is on a winning streak and you’ve worn a particular coat to the rink, don’t think you’re changing your coat now. You simply cannot mess with the mojo.

Hockey players have their own set of superstitions like taping their sticks a certain way, dressing in a certain order, wearing a particular undershirt, and playing a particular song in the locker room and for warmups. And then there are goalies, they’re so special. Watch a goalie at any level and you’ll see their superstitious ritual. Mine used to stand up hit the right post, the left post, and then the right post before moving into position. Marc Andre Fleury talks to his goalposts every time they give him a hand.

As for us parents, once we ensure we have the winning outfit/jacket on, we’re ready to head for the rink. Once there the routine is often the same, for me, it was to go grab a coffee from the nearest Dunkin’ or Starbucks. Naturally, this would lead to several pregame bathroom trips to ensure the bladder was empty before being trapped in the penalty box for the game. Other parents will sit in the same spot. Some parents, however, will move if the game isn’t going well. Goalie parents will migrate every period as will the forward dads. It’s crucial to the team’s success that every parent sit or stand at their winning spot.

Are you superstitious?

Sleepy

I’m so sleepy today. This spring forward an hour nonsense has got me all discombobulated. Now don’t get me wrong, I love the later sunset. I do, however, resent losing an hour of sleep and having to wake up when it’s dark. The Monday after the daylight savings time change should be a national holiday, much like Super Bowl Monday. Everyone should be given an extra day to assimilate before having to deal with the shit show that is a Monday.

Work was busy this morning, but things have taken a turn towards boring. I love being busy and talking to great people all day. It’s when it’s slow or folks don’t answer that I start to get restless and frustrated. At this point, I may put the headset on Anakin and take a nap. However, I’ll have to first wake up my sales assistant as he is currently napping comfortably on our bed. I do think Anakin’s gritty personality will lend itself to sales.

This weekend I finally ticked a few boxes off my to-do list. The Goodwill bags are now gone. My Hubby dropped them off for me Sunday morning. There were several bags in our room that needed to go, so the room looks so much better now. In addition to the Goodwill run, I organized my food storage cabinet. For some reason, keeping the lids and food storage containers organized is a real challenge for my boys. I had enough of the nonsense and straightened it out yesterday.

Which animal would you compare yourself to and why?