Health “benefits” from Centura called this morning. Hey, guess what? You know those scans? Not approved. What! Twice in two weeks? What’s going on?
In spite of being the patient, hereinafter to be known as the victim, of our health care system, I was having a hell of time accessing any of it.
I don’t like phones. I like to see the people I’m talking to, even if I know them. It’s a thing and I’ve had it for decades.
This morning, however, was a phone morning. I called United Health Care. Nothing had been submitted for approval. Say what? It’s the day before these scans which were ordered last Friday. Who submits these things for approval? The doctor.
Anova Healthcare. Amanda, the heroine of the morning, or good Amanda as I think of her now, answered. The Littleton office handles authorizations. OH, I thought. She’s going to make me call them. Nope. She called. Vanessa, who has responsibility for my case, would call me back. Amanda had talked to the manager of the authorization department. I assume the same one that failed to get my axumin scan through.
Anyhow, Vanessa never called. I got a call again from Centura where I learned of another authorization hurdle. It’s internal to New West Physicians and focuses on Medicare claims. Oh. AARP Secure Horizons, which Kate and I have, is a Medicare advantage plan administered by United Health Care. Apparently this is the first point of contact with potential payors.
Cindy answered. I’m sad and a little scared. Can you help me with this? The doctor ordering the test marked it as routine and Vanessa (bad Vanessa) only sent it to them yesterday at 3 pm. Oh, come on. The doctor had to change routine to urgent. Could you call the doctor? No, we usually don’t do that.
OK. Back on the phone. This time Amanda again. Answering machine. I told her what Cindy said. Amanda called me back in a short time. She’d already talked to Cindy. (Good Amanda) The bone scan is authorized. The CT is awaiting a decision. We’re half way there.
Here’s the thing though. All these phone calls, which took me all morning, were made by me, the victim. Ratcheting up my stress level each time. And, the result, which I sought all morning, was to get back to where I thought we were to begin with.
This left me with my head in my hands, talking to Kate at the dinner table, saying often, I don’t know. I really don’t know. A sort of ringing and head pressure came and went, my body trying to adjust itself to the feelings coursing through it.
I’m glad I’m not anxious, not much anyhow. But, I am stressed.
No scan. AARP Secure Horizons denied payment. When I asked how much it would be as a self pay. Pet scan, $2,600, axium dose somewhere between $1,000 and $3,000. Nope. And, I made the decision for the same reason AARP probably did. The scan’s accuracy is around 60% and that goes down the lower the PSA. My PSA is well above the reemergence marker of .2 at 1.3, but it’s still pretty low for imaging studies.
On this side of the wall, where you and I are, is the money used to pay everybody in medicine. If you are a one percenter, there’s a special gate you can walk through anytime you need it. You can access all of the excellent care that is available. If you’re the rest of us, no money passes through the wall unless several corporate, bureaucratic entities and individual people within them, say yes. Those entities include private, for-profit health insurance companies, medicare, medicaid, non-profit health insurance, banks, credit card companies.
Such a shift would eliminate all of the corporate gate-keepers who have an interest in profit for their company. Perhaps they could all go work for the TSA and use their previous employment experience to annoy the hell out of travelers.
Here is a cautionary tale about health care. On April 24th or 25th I scheduled my axumin scan for today. That’s twenty days ago. It’s purpose is to tell where my cancer reemergence is located and to help stage it. This after the rise in PSA caused consternation for both me and my urologist, Dr. Eigner. I was glad we could get it on the calendar so quickly.
Should I go in today, sign the waiver, and keep my appointment with the radiation oncologist on Friday? When I told Eigner my PSA rise, he said, “Get another PSA done and get into see me ASAP.” A post-prostatectomy rise in the PSA to .2 is a biochemical recurrence. That’s the clinical definition. Mine was at 1.3. Everyone I spoke with had a sense of urgency about this. That made me have one, too.
We hit month 7 since Kate’s bleed yesterday. (To quote the Grateful Dead.) Procedures and imaging. Trips to the emergency room. Trips to doctors. The gradual shift in roles at home. Things have gotten clearer, some solutions have appeared, but nothing certain right now.
Synagogue shootings. Mosque shootings. Church shootings. I’ve not read of any Hindu temple shootings, but if they’ve not happened, it seems inevitable. A Southern Baptist clergy said, “…no one should be gunned down in worship.” 
Jupiter hangs west of the Rushing Waters Moon while Antares sits below it, also to the west. Black Mountain has a faint reddish glow as dawn sun pushes up the Shadow Creek valley. In this light our lodgepole pines look lush, a vibrant healthy green against the red-tinted Black Mountain. Another Rocky Mountain morning.
Why? What we know now about sexual abuse is that it often (usually) involves an authority figure and a subordinate. Sexual desire hasn’t waned in the last two thousand years, I’m sure of that. And the Catholic churches presumption of holy authority and that mediated through its bishops and their clergy trumps even the boss/employee relationship, the coach/athlete relationship, and the doctor/patient relationship.
Tax day. Still puzzled by the acrimony taxes create. Taxes express our solidarity as citizens of this nation. They do the work of road building, of feeding the hungry and housing the homeless, of war fighting, of space exploration, of consumer and environmental protection. Or, at least they do under reasonable, non-tyranny leaning Presidents. I’m happy to pay them, federal and state and property. Always have been.
