Friday, August 5, 2016

Lupus and BCBS -- a deathly combination

Right now I feel like God does not love me anymore because I just was nasty to the nurse at Christie clinic.  She called to tell me that Dr. B will not change the code on the General Health Panel blood test to diagnostic, because it was not diagnostic.


When I call them, I pray before I call, and try to remember who I am in Christ and be filled with the peace of the Holy Spirit, because I know that these conversations are dangerous battlegrounds for my soul.  But when they call me, I don't have time for all that preparation.  I just have to pick up the phone and hope.

I had appealed for the change because the last time I spoke with BCBS they said that the GHP is not routinely covered with physicals and is not deemed medically necessary as a preventative test, and can only be covered if it is diagnostic.  This is the opposite of what Andrea at BCBS told me in June--she told me it would be covered under my preventative care if it were coded correctly--but whatever.  They change their story every time I talk to them.


My rheumatologist (KS, NP) wanted the same panel run, and I was (ironically) trying to save money by only running it once and sharing the results between the two doctors.  Dr. B told me that it would be covered as part of my preventative care (in full) so I thought it would be advantageous to have that particular test run through her and shared with KS, rather than the other way around.  I filled out a bunch of paperwork to be sure that KS would get the results, but I am not sure whether she ever did, and she had not received them by the time of my appointment with her, and she was annoyed about that, and although she maintained her composure and was polite, it was an uncomfortable experience for me.

Yes.  Apparently this was not the advantageous way to go.  At all.


...Even though I was assessed an extra charge for the actual  physical as well, because during the appointment we talked about lupus and reflux, according to the insurance company, who was looking at the diagnosis line on the paperwork.


So I asked Dr. B (submitted an appeal) to change the code on the GHP to diagnostic and connect it to the lupus so I could at least get it covered at 80%.  Heck.  I'm already paying $127 for uttering the word lupus in her stinking office.  Dr. B says that changing the code would be unethical, reports her nurse.  Dr. B says we only discussed reflux and not lupus.


I finally lost it and, practically in tears, told the nurse, "Look, I don't know what is covered and what is not covered, or how anything is coded, or what the codes are.  Somebody told me it was coded as diagnostic and needed to be changed to preventative, and somebody else told me it was coded as preventative and needs to be changed to diagnostic, and meanwhile I never see anything.  I'm helpless to do anything for myself.  I'm flying blind.  All I see is a bill for $305.00 that I was told would be covered, but now am being told is not, except it would have been covered at 80% if I had just had my rheumatologist run the lab instead of you.  You know what?  I have lupus.  And you know what else?  Lupus is triggered by stress.  You know what gives me stress?  Going to the doctor gives me stress.  And getting bills gives me stress.  Having the coverage of those bills denied by insurance, that gives me tons of stress.  So I guess I will just stop going to the doctor, and maybe I'll just die.  And then I won't have any stress any more."


She was silent for a moment and then she said, "I can see why you would be upset.  I wish I could do something to help you."  But she didn't say it compassionately.  She said it in that flat way that says, "It would be nice if I could do something to help you but I can't."  Perhaps she was reading off a card topped with the heading, "What to say if the patient brings up death."

So I replied to her, very brightly, "Yes, well apparently you can't help me.  So.  You have a good day now, but I probably won't.  Good-bye."  And then I hung up, because I was sick of her legalistic unhelpfulness.


And now I feel guilty.


I just hate this.  Hate this.  I cannot tell you how much I hate this.

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