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No Surprise

No surprise here, but I’m exhausted. These past couple of months, I have been unable to fall asleep. Honestly, it takes half a century to fall asleep. Once I’m asleep I’m good, it’s just getting there that’s hard. Thankfully, I have bloodwork in a few weeks to determine if my thyroid is the culprit. After all, it usually is!

While it’s no surprise I’m tired, it will come as no surprise that prior authorization approval is still pending for the Mayor’s Dexcom. When he was in the hospital in October, Cigna called and told us they would approve a CGM and insulin pump immediately for him. Cigna doesn’t have the best reputation, but they did the right thing. It is taking weeks for BCBS to approve the Dexcom 7. It’s unacceptable to me that BCBS would delay the medical equipment necessary to keep his blood sugar stable.

Perhaps I’ll sleep better when I’m not worrying about where his next Dexcom is coming from. I’m going to try calling again this evening. The doctor’s office reached out to BCBS yesterday. It’s so infuriating that I even have to fight this battle. At this point, I’m going to have to take it to the socials to get it approved. They already have confirmation of his type 1 diabetes and have paid for his insulin pump. This is just absolute insanity.

2025 Goal Tracker:

  • Run a 5K: in training
  • Complete Kayla Itsines program: in progress
  • No afternoon Starbucks (except for travel/vacations): I made it into February and haven’t buckled!
  • Top performer at work: on it!
  • Travel: working on it
  • Eat to lower inflammation: in progress
  • Read daily: in progress. I’m reading She Wolves by Helen Castor.
  • Get out of debt: in progress
  • Financial independence: in progress

If you could be someone else for a day, who would you be, and why?

If I could be someone else for a day, I’d want to be my Grandma T. I’d love to walk a day in her shoes with her memories and her experiences. The not-so-serious answer would be that I’d love to be Victoria Beckham for a day, so I can hang out with her husband David.

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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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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.

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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.