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Nonsense

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.

Today’s music video is Norwegian Wood

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The Saga

The saga continues. I finally got an alternative med approved for the one Cigna denied. As a reminder, I’ve been on the medication since 2021 and was paying $25 a month. You can imagine my shock and I logged it to Express Scripts and noted a co-pay of $1385.85. I’m so glad I’m paying an arm and a leg for this insurance every month. It is coming in handy over here!

I’m so tired of Cigna and other insurance companies being the alpha and omega of medical decisions. Despite Cigna’s unwillingness to cover antibiotics, the Mayor’s finger is finally healing well. Honestly, this broken-finger business has been quite the saga. And by saga, I don’t mean fun adventures like the Vinland Sagas. Once my big event pops off at the end of April, I’m going to focus my energy on making Cigna and Express Script’s life miserable.

When you were five, what did you want to be when you grew up?

When I was five, I wanted to be a doctor. Fortunately or unfortunately, I decided to go another path. I cannot imagine the frustration doctors must feel trying to provide care while wrestling with insurance companies.

Now here’s a song to bring out your inner dancer. Now back to the saga.

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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.

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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.

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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.