Insurance has made medicine absolute nonsense. I had a follow up appointment with my primary this morning. Aside from checking in, I felt compelled to share my recent experiences with Cigna. To say she could commiserate is an absolute understatement. She recently had an insurer deny a CT scan for a patient even after she did a peer to peer review. When the patient opted to pay out of pocket, the insurer told my doc that no issue found on that CT would be covered by them as they didn’t approve the scan. What absolute nonsense is that?
To make it worse, I wemt on X and saw all the politicians bragging about how they’ve made care more accessible and affordable. It’s honestly laughable because nothing could be further from the truth. The insurers act with impunity making it harder and harder for insureds to get care. Most people don’t have the knowledge or ability to fight back, which means there will be a bigger disparity in the healthcare people receive.
Anyway, it doesn’t help that I then come into work and deal with nonsense all day. At least the day has been consistent. I’m still on the pilot program, which means I spend my day watching British tv. I hate being bored and yet here I am. Also, Goalielocks went back to school, which is a bummer. Truly, I like having him home. The house is a bit more boisterous and joyful with him here.
How have you adapted to the changes brought on by the Covid-19 pandemic?
I’ve adapted by living my life and being considerate of others. If I’m sick, I don’t leave the house. Lastly, I try to be more kind.
Boredom has been a constant fixture of my weekday since last Wednesday. I don’t like being idle. I prefer a fast-paced, busy day that moves quickly. Now on this pilot program, boredom is the name of the game. The only silver lining to the situation is that I’ve enjoyed getting caught up on documentaries and British comedies. I’ve definitely learned a lot in the last week.
Whoops, got sidetracked harassing Cigna on X again. They finally approved a comparable drug to the one I’ve been taking the last two years. Those crafty bastards at Cigna approved something they don’t cover, so my co-pay is $1385.85. Last time I filled the script, it was $75 for a 3-month supply. Since going down the rabbit hole, I’m more convinced than ever that nothing will change. Given the amount of money these companies donate, really blackmail, to our politicians’ campaigns is sickening.
Our system is so irrevocably broken, it’s sad. The insurers and big hospital systems are dictating care to the detriment of their patients. We’re caught in between dishonest insurers that gate-keep coverage. Additionally, the corporate or private equity run health systems would rather you die than give you adequate care. Lastly, if I see another humble brag on X about more people having access to health insurance, I’m going to vomit. Access to health insurance is no longer synonymous with access to care.
What’s something most people don’t understand?
I think people struggle to understand autoimmune disease and how impactful they are to people’s lives. It’s hard for people to square a seemingly healthy looking person, who’s struggling with serious illness. Anyway, autoimmune diseases suck just as much as Cigna.
More coffee, please… There doesn’t seem to be enough coffee onboard to get me through this tedious Monday. My boss moved me to a pilot team last week, which has resulted in my absolute boredom and no sales. If there is an upside, it’s that I’ve been able to watch some great documentaries over the past few work days. I just finished one on the sophisticated Queen Elizabeth I.
Now I’m watching one on the London of Tudor England. Unsurprisingly, it goes along well with my obsession for reading all things Tudor or Tudor adjacent. Nevertheless, I hate being bored and unproductive at work. Especially when I’ve been having a spectacular month thus far. Hopefully, they move me off this pilot and back into a space where I can be successful.
While Monday is definitely calling for more coffee and patience, the weekend was pretty good. Goalielocks was here through late Saturday afternoon. I love having him home and wish Jake could have been home too. Having the boys in the house makes my heart full. It’s a different dynamic when your kid is visiting versus when they live under your roof. I did make some homemade sourdough Cinnamon Toast Crunch cereal for him to take home.
Aside from the fact I had to work Saturday, I did have a fun weekend. Friday night we had dinner with John and Hanh at Batch, which was tasty and fun. Afterward, we went back to their house to hang out while the Mayor got his occupational therapy. After work Saturday, we went back to their house to watch the Panther’s game. When we left their house just after 11:00, we got to see the rocket launch. From the road, we had a different view than what we can see from our house. For the first time, we could see the fireball streaking through the sky behind the rocket.
Sunday morning I headed to our Coffee & Collateral event for PanCan. We have the best affiliate group in the business. The morning was so much fun and time well spent. As a group, we were able to get our fliers and postcards into a lot of local businesses. Importantly, we were also able to cultivate some promising partnerships with a few businesses. One of the most powerful parts of this experience is hearing stories of how pancreatic cancer or cancer has impacted their life. While we raise funds for pancreatic cancer, cancer research can impact several other types of cancers.
Afterward, I got to baking. I whipped up two quick sourdough loaves. I intended to make the 24 sourdough loaf but forgot to start it Friday night. Once the loaves came out of the oven, I started on the fresh pasta we’d be having for dinner. I was a bit intimidated at first, but it proved to be easier than I expected. To be clear, it is a time-intensive exercise, but you could easily make the pasta on the weekend for use during the week. Truly, the effort was worthwhile. The difference between fresh and store-bought pasta is stark. I’ll try to post the recipe this week.
How often do you say “no” to things that would interfere with your goals?
I say “no” to things that interfere with my goals or routines often. Unfortunately, I’ve found that maintaining my routine is important when managing an autoimmune disease. Before I was diagnosed with Graves, I had a routine but could be flexible in making changes to the routine. Now if I change up the routine, the wheels fall off. I don’t like feeling like an outsider in my own body.
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.
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 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 Fivelast fall.
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.
Is there anything more aggravating than health insurance? I don’t think so. Today’s aggravation with Cigna comes from them doubling the price of my Synthroid on top of doubling my premiums. Of course, the generic is free, but unlike most drugs, Synthroid and its generic partners are not the same. Unlike other drugs, where generic may be just fine, doctors recommend you stick with what you start with. To change later would be disruptive due to differences between the drugs. This does work both ways, so if you start with the generic, you stay with the generic.
Cigna has been on my shit list for a while now. Firstly, I can no longer use the pharmacy I’ve used for 18 years. I guess they don’t want me using a pharmacy that has a majority stake in Aetna. Moreover, they’re refusing to pay for Hubby’s MRI because apparently, they know more about knee injuries than his orthopedic surgery. I guess they’d rather the surgeon root around in the operating room figuring out the scope of damage instead of the surgeon knowing and planning for it ahead of time. It’s an utter crock of shit.
What I’d like to say to Cigna
It’s aggravating because who has the time to fight with their insurance company? I’m grateful that my hubby’s injury isn’t emergent. At this point, we’d be better off playing roulette at the casino to cover our medicine bills than trusting Cigna to do the right thing by my family. After all, I’m on the hook for both the Mayor’s surgery and the Hubby’s. To be fair, I don’t think an insurer that faithfully covers their clients’ medical bills exists in this galaxy. If you find one, it’s like finding the Holy Grail. Anyway, I guess my overarching point is that Doctors should be dictating standards of care, not insurance companies and large hospital systems.
What were your parents doing at your age?
At my age, my parents were working their butts off, so my brothers and I could go to college. Their hard work and dedication to us allowed each of us to be successful. Now, I’m attempting to do the same thing with my boys. Also, when they were my age I used to make fun of them for going to bed early. Now here I am in bed by 9:00 pm every night. I guess we do eventually become just like our parents, which is just fine in my book because my folks are amazing.
For some time now, hiking the Mighty Five has been on my bucket list. It was always going to be a matter of finding the time between the hockey trips, work, and visiting Jake. Last fall the stars aligned, I had taken time off and bought tickets on Delta to visit Jake in Utah already anticipating him going down range again. Fortunately, things changed and he wasn’t going abroad again. Consequently, I decided we should take the time to hike the Mighty Five. After all, it would have been criminal for him to live in Utah for four years and never take advantage of the National Parks in his backyard.
My trip was eight days, which gave us six days to traverse southern Utah and all five of the parks. To plan the trip, I used the Wanderlog app, so I could share our itinerary with our family. This way if something happened on a hike and they didn’t hear from us, they’d have an approximation of where we were going to be that day. This was an important tip I came across when researching the trip. Several trails in these parks must be respected as they can quickly turn dangerous. Also, the parks are in remote areas and cell service isn’t a given.
Looking down the Virgin River at Zion National Park
To fine-tune the itinerary, I leveraged All Trails, the park services app, and several blogs to figure out the best trails to hike. This proved quite helpful although there was some disagreement between the park services and All Trails as to the difficulty of some of the hikes. Before you reach the park, it’s imperative to download the trail maps to your phone. While the trails at Zion and Arches were very well marked, it was not the case at the other parks. Each park has its guide to the park and trails denoting the difficulty of each trail.
Beautiful Bryce Canyon
There is a little extra planning that needs to go into both Arches National Park and Zion. If you want to hike Angels Landing, apply to the lottery. You can no longer hike this trail without a reservation. Similarly, you’ll need to be extra prepared to hike the Narrows depending on water temperature, depth of the virgin river, and weather conditions. As for Arches, you’ll need to reserve a timed entry window for admittance into the park during the high season. Like Angels Landing, the Fiery Furnace hike requires a reservation.
Even with a lot of planning, go into the trip knowing that you may need to be flexible on your expectations. There could be changes in the weather or rock falls that impact your ability to complete certain hikes. Moreover depending on what season you’re in, there could be road closures up in the mountains. The best time to plan a trip is spring and early fall. This will give you decent weather without all the crowds of high season. We were there in early October and the parks were still super busy. And of course, bring plenty of water both with and without bubbles. Jake and I would enjoy cold, crisp sparkling water at the top of every hike.
Hickman Bridge at Capitol Reef National Park
We started our trip at Zion staying in Cedar City, which is about 45-55 minutes north of the park. We have two full days at Zion. However, I would have gladly spent more time there. The next park we hit was Bryce Canyon, which was under two hours from Cedar City. We stayed in Cannoville, Utah, which is a tiny town that doesn’t have a post office or cell service right off Utah’s Scenic Byway 12. This was our base for both Bryce Canyon and Capitol Reef Park. Our last stay was in Moab, which is near both Canyonlands and Arches National Park.
Canyonlands National Park
I planned for a full day at Bryce, Capitol Reef, and Canyonlands with 2-2.5 days at both Arches and Zion. Additionally, I planned 2-4 hikes a day or about 10-13 miles. Jake and I both trained for the trip, so we’d be able to tackle the more challenging hikes. I’d recommend that anyone looking to hike these parks do the same. We could have spent several more days at each park. Moreover, we could have spent another month exploring the incredible landscape around these parks. Interspersed between the national parks are several incredible national monuments, national forests, and state parks. There is something incredible to see at every turn.
Delicate Arch at Arches National Park
What I didn’t expect was the incredible drives between the parks. The drive from Cedar City to Bryce Canyon was breathtaking. Scenic Byway 12 was one of the most harrowing, yet beautiful drives I have ever taken. From the steep drop-offs and beautiful views of the canyons in Grand Staircase Escalante to the beautiful high mountain road with free-range cattle and changing foliage, southern Utah is one of the most beautiful places I have ever seen. The drive alone between Bryce Canyon and Capitol Reef is worth the flight to Utah. I’ve written about our time at Zion and will be writing about our experiences at the other parks. If you’re on the fence about a trip to the Mighty Five, get off the fence and do it.
Something on your “to-do list” that never gets done.
The one thing that never gets checked off the “to-do list” is dropping off the donations at Goodwill. They seem to sit and sit in the garage for months or even years on end. I’m not even sure why that’s the case as it’s not difficult to drop the stuff off. Yet here we are with stacks of bags to be donated.
This week I found myself getting started again on my workout routine. Illness knocked me out of my routine over the holidays. I had resumed it, but a trip and then another stomach bug interrupted my progress. Unfortunately, last week’s bug knocked me out, so I took a week off to recover. Yesterday I started again with an amazing cycling routine with Emily on Apple Fitness+. Today’s workout was a Rihanna-themed treadmill workout by Sherica. As always, the workout was fire.
Taking a week off every few weeks is a nightmare scenario for me. It’s challenging after making so much progress over the late summer, fall, and early winter. Now I feel like I’ve lost some of those gains and am back at square one. Thankfully, the difficult part, which is getting started, is over. The trick is to be consistent and disciplined like I was throughout the fall. Hopefully, it warms up just a tad, so Arrow and I can return to running outside again. I’d run with Anakin, but honestly taking him outside to walk is akin to a CrossFit class. He wears me out.
What do you complain about the most?
At the risk of alienating myself or sounding too cliche, I complain the most about the quality of consumer goods. Not only does this make me feel old and that I’ve turned into my mother, nay my grandmother, but it grinds my gears. For example, we are on our 4th washer and 4th dryer. We’ve lived in our house for 17 years. These appliances should have a shelf life greater than four years. When they sold my great aunt’s house a few years ago, it had a washer and dryer from the 1960s that worked better than my current duo work.
One could argue that three hockey-playing boys take a greater toll on a washer and dryer than aging adults. However, I don’t expect my washer/dryer to last fifty years. I do expect them to last at least ten years. Honestly, I don’t think this is an unreasonable ask. I know I’m not alone in this as family and friends have experienced this with several different appliances, so there’s some truth in the cliche “They don’t make things like they used to.”
