When it rains it doesn’t always pour!

Yikes! What a crazy couple of weeks!!!! So after my meeting at Shands, I got right on my PET scan. I left Shands without a referral for the scan but thought it would be fine to have my Interventional Radiologist (IR) put in the order as he would review it to see the status of the liver and decide if an ablation could be an option. His office put in the order but we needed to have my insurance approve it first. We unfortunately had to switch insurance and we now have Cigna (I am purposefully naming the company as I think it may be helpful for people having a choice in which insurance company they will pick). I totally freaked when I first heard we had to switch to this insurance company, as a provider, Cigna has been one of the most annoying company to work with. They would consistently deny my claims the first time I would send them in, probably hoping I would forget to resubmit them a second time in the time frame I had to bill. They would magically pay the 2nd time around but this was so much time consuming for me and a real pain in the butt. We had had the same insurance company for years and as much as I always joked about how they were probably looking forward for me to kick the bucket because my care was so expensive, never did they make me feel that way. They have always approved every scan, procedure, and surgery that my doctors recommended. They even had a nurse call me from time to time to make sure I was doing fine. BCBS has been great for us. So I was not really surprised to hear that Cigna denied my PET scan. I got on the phone with them, struggled to have them find me in their system as my last name was misspelled on my ID card and when that was finally taken care of, they forwarded me to MedSolutions, a company they hire to review their cases. Seriously, I feel like everyone I talked to was not very competent and just couldn’t care less about my plea to get this very important scan approved so that I could get the care that I needed. I called Shands to see if they could help and my doctor’s nurse called them up and told me that she was pretty confident they would approve the scan with all the information she had provided. I now had to wait the weekend and would be getting an answer by Monday 5pm. A week had gone by already and I was really trying to get this scan done before our trip to Quebec. At 4pm on Monday, I decided to call my friends at MedSolutions to have the verdict, feeling pretty optimistic that it had been approved. I was a bit shocked to hear that they had denied it a second time. I could file an appeal that they would review! I have no idea how long that process would have taken and I was determined to not have to go through this route. I was livid on the phone. I questioned the qualifications of the doctor who had reviewed my case and was told he was a radiation oncologist – a specialty I had never had to consult before as radiation is not an option in my case – so really what this doctor really know about my specific case? How could someone who doesn’t know me from crap can make such a decision when I have 2 doctors who have known me for more than 2 years say this is what is needed at this time. I was not asking for a facelift just to look younger, I was asking to be injected with a radioactive dye and then lie in a very uncomfortable position for 25 minutes to enable my doctors to see my insides! They obviously did not let me talk to their good doctor as their doctors don’t talk to “patients” (boy oh boy I am so glad that these are not my treating doctors!). I was so mad that I even told the person on the phone that I would send him a personal invitation to my funeral so that they can explain to my kids why this scan was not approved (thanks Dawn for the tip!). Even that didn’t phase him, I really feel like everyone I talked to couldn’t care less. So I bothered by GI Oncologist at Shands again. I feel badly that doctor’s who are busy seeing patients and actually saving lives have to take some time of their crazy schedules to deal with this BS but my amazing doc got on the phone with them the very next morning and magically the scan was approved! phew… I could breath again! So we were then Tuesday and we were leaving in 3 days! I called the center where I was going to have the scan to see if there was any chance I could get scanned by the end of the week. I had the authorization number from my insurance but I was told they could not book the scan until they received the confirmation fax from Cigna despite already having the authorization number! Back to calling Cigna to see if they could fax the form over… “it will be faxed before 5pm ma’am”. I called back the center, pleaded my case some more and was “penciled” in from Thursday afternoon! Another hurdle conquered. Then I got a call on Wednesday from the center informing me that their PET scan machine broke down, that they thought they would have it fixed in time for my scan but would know for sure in the morning! I couldn’t help laughing at my great luck with this scan!!! Well thankfully they fixed the machine and they had me come in just a little later that day and I had it done without any glitches! I asked for 2 discs, one for my IR and one for Shands. I immediately drove to my IR’s office to get him the scan and when I got there, they were closed for the rest of the day lol…. My hubby said they probably knew I was coming and decided to flee… hahaha! I texted my IR and made plans to drop it off in the morning. So Friday went by as I was desperately hoping to get a call from my IR. I did look at the images myself and only saw one spot on my liver but I couldn’t really interpret the rest… I still don’t understand how radiologists can make sense of these images! It was about 6pm when the phone rang and it was my Dr. D.!!!! I was so psyched to hear from him, I really wanted to know before I left. So here is the really good news: there is just one spot lighting up on my liver!!! This is pretty incredible given that I have been “just” on maintenance chemo for 2.5 months and my scan 3 months ago was showing 4 active spots!!! aaaaaand nothing else lit up! My IR put a little damper indicating that he wasn’t sure if that one spot was the cause of the rising CEA (cancer marker) but he then added “who knows it might be from the tumors dying” and I said I liked that hypothesis and he said he knew I would like it lol! Nothing like a doc that really gets you! So the plan of action is: another scan!!! this time it will be a MRI with contrast which will be a lot more precise for him to locate the tumor and be able to ablate it. I am hoping to get this (scan and ablation) done as soon as we return and we are trying to plan all this around my work schedule and before he leaves for a week. Now I hope Cigna will approve the scan without making us jump through hoops. So needless to say it has been a bit of a stressful two weeks but we are now on our way to Quebec where will get to forget about all this craziness for a little while!

There is a lesson here though: the sun always comes out, when it rains, it doesn’t always pour! patience paddlleboardgirl…. patience…


2 thoughts on “When it rains it doesn’t always pour!

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