Warning: the following entry contains references to Girly Bits and includes the words “uterus” and “ovaries”. Please procede at your own caution.
I’m a Kaiser baby. Kaiser is what I call a “full-inclusion” HMO. You pay your premium, and when you need services, you go to Kaiser. For everything. Labs, x-ray, emergency, surgery, flu shots … you name it, Kaiser does it. All the services are in the same building, and there’s no such thing as deductibles, “reasonable and customary” charges, and no treatment administered is ever charged for, because it’s all their facilities and doctors. You even get your prescriptions from their pharmacy. You walk in, pay your office visit fee ($15-20) and get your services. It doesn’t matter if you’re being seen for a cold or for a shattered bone, it’s the same fee. It is the perfect healthcare system for a cash-strapped individual. You never get any surprises.
It’s a beautiful system, especially when bad shit happens. Remember when I got hit by the RV a few years ago and had two ambulance rides, four CT scans, a day and a half in Intensive Care, and tons of drugs? Instead of thousands of dollars in co-pays, deductibles and denied services, Kaiser picked up the tab for a single hospital admittance co-pay of $200. That was it. No other out of pocket, no haggling over prices, no questions asked. You have to love that.
I was a member of Kaiser from the time I was three months old until last September. I would still have Kaiser, but they don’t have a facility up here, so that was the end of that. I am now being indoctrinated into the amazing world of “normal” health insurance – one of those Blue companies.
Back in January I finally got around to getting us an insurance plan. I had to, since I was out of birth control pills and needed a refill. So a space of mere days elapsed between the establishment of my new policy and my first visit to my gynecologist. I was only there for a checkup and a prescription. But fate had other things in mind.
Imagine my surprise when the doc was doing my pelvic, looked up and said “Has anyone ever told you that you have an enlarged uterus?” Seems that sucker was about the size of a 14 week pregnancy. And I wasn’t pregnant. After further examination (and an ultrasound), it was discovered that I have a very large fibroid tumor that’s hanging on a stalk and has semi-engulfed one of my ovaries. In February it was measured at 12cm (about 4.75 inches). According to my doctor, I should have been doubled over in pain several months ago. Since I have a very sick since of humor, the tumor now has a name. We call her Myrtle.
There were lots of decisions to be made – treatment, surgery, pre-surgery treatment, and ultimately my entire reproductive future. The doctor said I could go into a chemically induced menopause to shrink the tumor, but I rejected this idea because 1) I hate the idea of fucking with my body chemistry that way, 2) the idea of menopause doesn’t thrill me, 3) it was only a suggestion, not a necessity, and 4) the shots to do this were $400 each, not covered by my insurance, and three shots were recommended. I declined that course of treatment. Since there were other major catastrophes brewing in our lives and I wasn’t in pain, the doc said we could put off a decision for a while.
Meanwhile, my new insurance company started throwing up red flags at this person who claimed to be healthy but was carrying around a big honkin fibroid. Color them suspicious. They immediately started denying claims, saying this was a pre-existing condition. My doctor wrote them a letter explaining that while yes, the condition was technically pre-existing, it didn’t qualify as such because I had no symptoms and was utterly clueless that I was harboring such a beast. The insurance reinstated the claims and we all went about our merry way.
In mid-May Beau Hunk and I met with the doc again, decisions in hand. We came to the conclusion that given our questionable genetics and my age, we would forego having kids. That was not exactly an easy conclusion to reach. But it’s the safest and most reasonable way to go about this, so it was decided that I would have a hysterectomy on May 31st. The doctor requested that I have an MRI first so she would know exactly what she was dealing with.
I had the MRI at 7:30am on May 25th. By 9am my doctor’s office was calling my house to talk to us because she didn’t think she could operate in six days. WTF?? We saw her on what was supposed to be her day off, at 1pm on a day when her office was supposed to close at Noon. It seems the our darling Myrtle had grown to almost 6″ x 4″ x 3″, and the stalk was 1.5 inches and “remarkably vascular”. So much so that the tech reading the MRI called her immediately with the results. Something the doc said has not happened in 10 years of practice. The doc said she had “visions of my patient bleeding out in front of me”. You know, I never want to hear the words “bleeding out” from my surgeon.
Alternatives were discussed: I could take the shots which would put me into temporary menopause – the idea I had previously rejected, or they could do a procedure where a few days before the hysterectomy a surgeon would “kill” Myrtle’s blood supply to reduce surgical bleeing. I liked that last idea, but the risk there is that my doc has never come in behind this procedure and done a hysterectomy. It’s usually used for limb amputation, not gynecological uses.
Eventually I decided on the chemically induced menopause as the safest route with the least possible complications. But because there’s a 4-8 week recovery and I’m supposed to start school on August 22, there definitely wasn’t time for a full three months of menopause treatment. So the doc and I compromised, deciding I’d have two shots and surgery on August 2nd, and I’d just find a way to make school work on three weeks of recovery. Unfortunately, her office put me through a two week clusterfuck where they were supposedly trying to see if my insurance would cover the shots. Which I had already told them wasn’t going to happen, because I had checked it out on the web first. So the first shot didn’t happen until June 13th.
This is where I start my rant about non-Kaiser healthcare. So now we’re two weeks delayed on the already shortened plan to put me in menopause to shrink our darling Myrtle because of insurance insanity. Finally all the pieces are in place and I can go to the pharmacy, pick up my shot, drive down to my doc’s office so they can shoot me in the ass. Imagine my joy and ecstacy when I find that the shots were not $400, as my doctor said, but really cost $627. Each. Did I mention they weren’t covered by insurance and they don’t count towards deductible? I repeat, joy and ecstacy on my part. But I paid it, because the words “bleeding out” were still ringing in my head.
So the joy of menopause began. I kid you not, the very first night I had voices in my head that were completely insane. The thoughts pinging around my skull were completely irrational, and I knew it. Luckily, they calmed down in a few days. Only to be replaced with hot flashes, night sweats, depression and crying jags. All I can say is that my husband has the patience of a rocking horse. He’s been wonderful about the whole thing.
No sooner had the first shot been given than my doc called me, for reasons that I can only describe as being the covering of her own ass. She started telling me that I should be aware that the best course of treatment would have been to have three shots, not two, with a full four weeks after each shot before surgery. She said “And I’ve made a note in the file that if the patient requires a blood transfusion and gets Hepatitis-C, she was aware of the risks.” Excuse the fuck out of me? She signed off on this treatment plan on the front end, and now she’s backpeddaling? I swear, I don’t need this shit. I really don’t.
So I brought up the idea of donating my own blood for my surgery. She said she was against it because they like six weeks to pass between blood donation and surgery. At which point I wondered why in the hell she hadn’t brought this shit up during our consult at the end of May. But anyway. I called the bloodbank who called Bullshit on her six weeks, saying it was ok to donate to yourself as soon as two weeks before surgery, oh, and by the way, you can’t give to yourself more than 30 days prior to surgery because they can’t keep it that long. I called the doc’s office with this info, and the receiptionist told me I couldn’t give closer than four weeks to surgery. At which point I finally lost my shit. I told her “Look, the doctor is telling me six weeks, the blood bank says two, and you’re saying four. Now I’m really confused. Can you just get an answer for me?” I don’t like to be an ass to someone who is trying to do their job, but really folks, can we really be this fucked up??
I gave my first pint to myself last Thursday. I’m scheduled to give another tomorrow. Oh, and I found out that this procedure costs $300 per pint. I asked why I could give to a stranger for free, but I have to pay for my own. I never did get a firm answer, but I guess it is a giant pain in the ass to set it aside and make sure I get it. I’m still willing to pay rather than take any chances. I also found out that I forgot to ask the $64,000 question when picking a blood bank – are you a preferred provider?? I found out too late that the answer was “no”, so I have no idea what’s going to happen now. I suspect I better open up my wallet, a procedure to which I am rapidly becoming familiar.
Which brings me to the heart of my BigBlue medical insurance rant – they are again putting all my claims on hold, trying to deny them for being pre-existing. Only this time they’re not taking anyone’s word for it – they’ve requested my medical records from Kaiser for the last three years – medical, psychological, prescription, AIDS testing – everything. Not that it really matters, because I have nothing to hide. It still kind of pisses me off, but I guess I understand their thinking and don’t blame them. I hate it, but I don’t blame them.
What I do blame them for is the shitty way they’re treating me. They’ve suspended processing of all claims until they get the records. But they don’t seem to be in any hurry to get the records or review them. Also, they wouldn’t give my doc’s office a pre-auth for the surgery until I pre-paid my premium (which they’ve already raised) for July 15 – August 15. Twice I tried to pay in early July, but they kept telling me my card was declined, even though it’s the card I use all the time. My card became magically good again when I was paying current, not paying ahead. Assholes.
I did hear from someone who is reviewing the records who had a minor question about some prescriptions I said I have, but the reviewer couldn’t find in the records. I know I have nothing to hide, and the call from the reviewer makes me think they’ll realize I’m being more honest than I have to, but I still hate this process. Meanwhile, the medical providers are starting to send me bills, wanting payment because the insurance has suspended processing until after they review my medical files. So Blue wants my money, the providers want my money, and Blue isn’t paying jack shit. You know, I pay your bills, so just do your damned job and do what I pay you for!
Well. I think I got that out of my system. For a minute.
So as we stand right now, surgery is scheduled for the morning of Wednesday, August 2nd. If you are a reader of Secra, then I guess you’ll get to be doubly entertained / horrified by post-surgery recovery stories. Well, unless I end up spending seven weeks in menopause hell for nothing and end up bleeding out anyway.
A possibility that I am doing my very best to ignore.