My new autonomic cardiologist wants to hospitalize me for tests!!!

[Kati]

That is indeed very annoying and something you could do without. i am very sorry @Gingergrrl. i am hoping your cardio can be very helpful so you do not have to pay any of that.

i am keeping all fingers and toes crossed and hoping you keep distracted till then.

 

[MeSci]

To backtrack to the original purpose of my thread (my new cardio hospitalizing me) I just got a bunch of statements from my insurance (Blue Shield) saying that they are only paying for the first day of the hospitalization (I was there for five days) and they are still not paying for the CTA (CT angiogram) that my cardio ordered b/c they still say it was medically not necessary even though the head of the cardiology dept at the hospital (my cardio) says it was!!!

To top it off, as of today, I no longer even have this insurance and now have an Obamacare plan through Covered CA. I don't have the energy to contact BS or file an appeal or whatever will be needed and they have not yet actually sent me any bills. I see my cardio on Oct 10th and will discuss it with him. He did what he felt was needed and I do not blame him in any way. It is just so annoying to have to deal with this now.

Bummer! Hope it can be sorted out.

Sometimes I am really grateful for the NHS - when it works, anyway!

 

[zzz]

Bummer!

Really! @Gingergrrl, I'm sure your cardiologist is as surprised as we are at this turn of events. Things didn't used to work this way. So Blue Cross paid the absolute minimum they apparently had to - for your emergency admission - but then wouldn't pay for one of the main tests related to this admission and needed to determine treatment? (IIRC, your cardiologist did believe you had ischemia at this point.) And then, having paid for your hospital admission but not the most important test, they decide that you don't need to be in the hospital anymore and won't pay for any more hospital days? This doesn't even sound rational. It would appear that they noticed that you had applied for the CTA scan earlier, figured out what your cardiologist was doing, and decided they weren't going to let him get away with it. They clearly weren't interested in what was medically best for you.

However, what your cardiologist did was medically sound, and the idea that some insurance bureaucrat could decide better than he what you needed is ridiculous. You may have to go through an appeals process, but truth is on your side here. (And so is your cardiologist.)

To top it off, as of today, I no longer even have this insurance and now have an Obamacare plan through Covered CA.

Consider yourself lucky. Blue Cross / Blue Shield generally have good insurance companies across the country, but the California one clearly isn't up to par. It doesn't matter what they say your coverage is if they don't actually pay for it.

I don't have the energy to contact BS or file an appeal or whatever will be needed and they have not yet actually sent me any bills.

Fortunately, you don't have to do anything until you get the bills. Then you'll have a reasonable period to file an appeal.

I see my cardio on Oct 10th and will discuss it with him. He did what he felt was needed and I do not blame him in any way.

No, this wasn't his fault at all. He got completely blindsided here. But I'm sure he'll do whatever he can to get Blue Cross to change its decision.

It is just so annoying to have to deal with this now.

Really. Sorry this had to come at you at all.

 

[Gingergrrl]

@zzz

@Gingergrrl, I'm sure your cardiologist is as surprised as we are at this turn of events. Things didn't used to work this way. So Blue Cross paid the absolute minimum they apparently had to - for your emergency admission - but then wouldn't pay for one of the main tests related to this admission and needed to determine treatment? (IIRC, your cardiologist did believe you had ischemia at this point.) They clearly weren't interested in what was medically best for you.

I am not sure what my cardio even knows at this point although it looked like a copy of the letter denying the CTA scan was sent to him. I see him for an appt next Fri but want to focus on clinical issues and it annoys me that I now have to waste my time dealing with this stuff. It was actually Blue Shield (not Blue Cross) just to clarify. And yes, even my first cardio agreed with my new cardio (when they spoke) that I should have the CTA to rule out a blockage as a possible cause of the ischemia. Believe me, I will be appealing this decision.

However, what your cardiologist did was medically sound, and the idea that some insurance bureaucrat could decide better than he what you needed is ridiculous. You may have to go through an appeals process, but truth is on your side here. (And so is your cardiologist.)

I agree that truth is on my side and the only way for my cardio to see that the ischemia was not due to a blockage was to do the CTA. I have family history of heart disease and he was not prepared to say my severe shortness of breath was all autonomic without this test. He felt it was most likely autonomic and that I would most likely benefit from Midodrine (which so far I am and it may turn out to be the miracle drug for me!) but he would be negligent not to assess and rule out other causes when my exercise echo showed ischemia. I am fully ready to appeal this with Blue Shield.

Fortunately, you don't have to do anything until you get the bills. Then you'll have a reasonable period to file an appeal.

I don't have any bills yet so I have no idea what they are going to attempt to charge me. It is possible they will still approve additional days of hospitalization in a future letter but the CTA test they clearly denied in writing.

No, this wasn't his fault at all. He got completely blindsided here. But I'm sure he'll do whatever he can to get Blue Cross to change its decision. Really. Sorry this had to come at you at all.

Thank you and I agree it was not his fault. He advocated for me and I am very grateful to him. It is too bad that doctors are no longer able to make their own decisions re: what tests or treatments are necessary for their patient and he is the head of cardio dept at his hospital!

ETA: Different topic but earlier in the thread (unless it was another thread or PM?) you said that Dr. Goldstein could do some kind of "receptor profiling" to see if an individual patient was a good candidate for something like Florinef or Midodrine. I may be horribly misquoting you and apologize! Can you explain what that means (I think it will benefit others besides me) and if this is still done by any other doctors? Thanks and no rush.

 

[Little Bluestem]

@zzz
when I look at all of the amazingly kind and beautiful people on this board who have not recovered, I think why would I be different?

Because you are recently ill (around here 2 years is recent) and are receiving good care. Many of us had no diagnosis and did all the wrong things for years.

 

[Gingergrrl]

@Little Bluestem Thank you and I try to remain optimistic that I will get better but it is so hard on most days. I want you to know though that it is much easier for me to be optimistic for others, no matter how long they have been ill, and all you guys on the board who have not given up are an inspiration to me.

There is a quote from an interview with Jen Brea (don't know which blog or site I read it on) and she said that there were people who were sick with ME/CFS for many, many years and then the 350th treatment that they tried was the one that worked and they got better. And she has met and interviewed these people for her film and based on real experience, not fluff. So, her quote reminds me to never give up hope no matter how hopeless it may feel.

 

[Sushi]

@Gingergrrl

You are in a better situation than patients who have been sick for many years for several reasons: 1) recovery is much easier when you start treatment early (as you have), 2) there is much more known about this illness than there was ages ago when many of us first started getting symptoms and we were entirely dismissed by doctors, and 3) you went, almost directly to a doctor who keeps up with the latest research and the treatment that other doctors have found beneficial.

I'd say you are doing really well with handling this extremely difficult illness.

Sushi

 

[Gingergrrl]

@Sushi thank you for the support and kind words that I am handling the illness well and it means a lot coming from you who I respect so much.

I debated posting this but today is my birthday and I am trying to view it as a new start. Strange coincidence, I've been keeping a journal of each day since I started Famvir (to track meds, side effects, and now BP on Midodrine) and yesterday was the last page in the notebook so I started a new notebook today on my birthday (by pure chance!)

 

[OverTheHills]

Best wishes for your birthday I hope your next year is one of improvement. OTH

 

[zzz]

Happy birthday, @Gingergrrl! May the coming year be one of increasing health and happiness!

 

[Kati]

@Sushi thank you for the support and kind words that I am handling the illness well and it means a lot coming from you who I respect so much.

I debated posting this but today is my birthday and I am trying to view it as a new start. Strange coincidence, I've been keeping a journal of each day since I started Famvir (to track meds, side effects, and now BP on Midodrine) and yesterday was the last page in the notebook so I started a new notebook today on my birthday (by pure chance!)

Happy birthday @Gingergrrl Best wishes!

 

[Gingergrrl]

@OverTheHills @zzz and @Kati Thank you all so much for the birthday wishes and I really appreciate it!

 

[MeSci]

@OverTheHills @zzz and @Kati Thank you all so much for the birthday wishes and I really appreciate it!

Happy birthday from me too!

 

[Hanna]

@Gingergrrl Happy Birthday and lots of wishes for bright future!

 

[Gingergrrl]

@MeSci and @Hanna thank you for the birthday wishes and to anyone else if I accidentally missed your post! It means a lot to me and really appreciate it!

 

[Kati]

@Gingergrrl did you have a good one?

 

[JAM]

Happy belated birthday! I hope you had a good day. Here's to a happy birth week!

 

[rosie26]

I am late............" Happy Birthday Gingergrrl"............ Hope you had a good one.

 

[Gingergrrl]

Thanks @JAM and @rosie26 and you are most certainly not late! I am not celebrating w/my family until next weekend and pretend Oct is my whole b-day month LOL.

I wish we had a list or system of all the PR birthdays (for those who chose to participate of course) so everyone could get b-day wishes. @Sushi Has this ever been attempted?

 

[Sushi]

I wish we had a list or system of all the PR birthdays (for those who chose to participate of course) so everyone could get b-day wishes. @Sushi Has this ever been attempted?

In the early days we did a lot more "birthday celebrations" but somehow, as we grew so much larger, it fell away....

Sushi