The Closet Professor

Lately, I have been breaking a cardinal southern rule. My mama raised me that when someone asked you, “How are you doing?” you should always answer with one of the following phrases: I’m good, I’m okay, I can’t complain, etc. The problem is, I’m not doing good. I am in near-constant pain with periods of more intense pain. The Botox treatments for my headaches were working, but for some reason, they haven’t been able to handle the current painful headaches I’ve been having. For a month or so, I have compromised with saying, “I’ve been better.” Yesterday, a coworker asked if I was feeling better; I simply responded, “No.” I’m tired of trying to put on a brave face and say that all is okay. It is not. I haven’t gone so far as to be brutally honest and say, “I feel like shit, and I am always in pain.” I’m getting close, though.

My mental and physical state is declining. I am tired. I am depressed. I am at my wit’s end. I need some answers. Maybe I will be able to get some after my MRI next Tuesday. I talked to the nurse at the Headache Clinic, and she had talked to my neurologist about which MRI I needed to have: the closed or open MRI. She recommended that I get the closed MRI because the images are better, and if there is something small, the closed MRI is more likely to catch it, whereas the open MRI might not. I made the earliest available appointment: Tuesday night at 7:30 pm. So, next Tuesday, I will drive down to New Hampshire and have the MRI. I’ve never been fond of driving long distances at night by myself, but I have done it before, and I can do it now. I didn’t want to have to wait even longer for the MRI.

Luckily, I got a notice from my insurance yesterday that they have approved the MRI, and they did not specify which one they would allow me to have. The letter just said that Cigna approved me for an MRI with and without contrast. Cigna’s Informed Choice Team has not tried to call me again to attempt to convince me to have the cheaper MRI, and I’d refuse if they did. Cigna’s Informed Choice Team told me the first time that it was my choice. Yesterday, I got an email from Cigna with the subject “Tell us about your Cigna service experience.” They should not have asked me that because I rated my experience very low, and I told them exactly why it was such a terrible experience. I know they will dismiss my criticism, but they need to know that they cost me a week in getting a test that could be essential in diagnosing the problem and possibly saving my life if the MRI shows something terrible. I pray that there is nothing deadly found, but I want to know what they might be able to find out.

When doctors in the past have ordered CT scans, x-rays, or other tests because they could not diagnose what was wrong with me, it has each time turned out to be something. Once, it was pneumonia. Another time it was epiploic appendagitis, an uncommon, benign, self-limiting inflammatory process of the epiploic appendices. Luckily, that time it was not appendicitis. The most recent time I had an x-ray, they found bursitis and arthritis. Luckily, none (other than the pneumonia diagnosis) was anything horrible, but it did provide peace of mind. Mysterious pain can cause all sorts of psychological issues when doctors have a hard time diagnosing the cause of the pain. For me, at least, I begin to wonder if my pain is even real, though I know that I feel the pain. The worry and depression can cause further health issues.

While I talk about my pain and health on this blog, I only talk about health issues with those closest to me in real life. Susan hears all about it and is always helpful in alleviating my worst fears. My mother hears about it when she will actually listen.  But most of the people in my life, I rarely tell them about issues I am having. I don’t want to be seen as a complainer, and I don’t want their pity. I want people to understand, but I do not want pity. I talk about my health on this blog because someone could have the same health issues, and it helps to know that you are not alone. I want to help others if I can, and I would like to know that I am not alone.

If you work for a health insurance company, I am not directing this post at you, but at the healthcare industry in general, especially how health insurance companies treat us. I also blame my university’s human resources department for not providing better healthcare insurance for its employees. I have had costly health issues before, but my current headache treatments have been the worst so far in dealing with my insurance company.

It began when my neurologist prescribed me Emgality and Migranal for my headaches. These are expensive drugs, and my insurance company, Cigna, denied both. My doctor appealed the decision, and they approved it. They denied Emgality because I had not tried Aimovig or Botox first. When Emglaity proved not to be effective enough, my neurologist prescribed Aimovig, but Cigna rejected that too. Again, we went through the appeal process. Aimovig did nothing, so we moved on to Botox. Also denied, again appealed. The Botox has been the most successful, but whatever the cause of my current headache is, the Botox can’t handle it, just as the nerve block and steroids did not help.

I have been struggling to get an MRI scheduled to rule out a tumor or other brain disorder for the past week. My doctor scheduled my MRI at the hospital, but my insurance company called and said that it would cost me over $2600 out of pocket, and I should schedule it for a place called Open MRI because that would only cost about $700. They did not explain that open MRIs are inferior images, but that’s not the worst of it. Cigna canceled my MRI at the hospital, but they screwed up rescheduling the MRI at the other place. Cigna mishandled it so badly; I ended up calling my neurologist and asking for help straightening this out. My neurologist’s nurse explained that I might need a more sensitive MRI if the problem happens to be very small. It might not show up on an open MRI image. The nurse will talk to my neurologist first thing this morning and decide if I need the regular MRI or the open MRI.

The insurance company’s issue isn’t really about saving me money, but about saving them money. If I have the MRI at the hospital, it will cost Cigna around $2000, but if I have it at Open MRI, it will cost Cigna just $210. Yes, they may be slightly motivated by helping me, but they are pushing me to have an inferior diagnostic test because it will save money. We shouldn’t have to worry so much about the cost of healthcare. Stress has such a detrimental effect on our health, and to have to worry about the costs of healthcare and can we afford the treatment we need is very stressful. It is so shameful that we are one of the most industrialized and wealthy nations, and we cannot provide affordable healthcare for our citizens. I hate that so many Americans are afraid someone will get more of something than they will.  Human greed is a major problem, and people don’t want to give up something, no matter how small, so someone else can live a slightly better life. 

I don’t get why insurance companies have the power to choose what treatment we can and cannot have for conditions, especially chronic diseases such as my migraines. The United States needs serious healthcare reform. We need to have doctors be able to prescribe treatment and have those treatments be affordable. Millions of Americans go into massive debt over healthcare costs. Nearly twenty years ago, when I worked for a bankruptcy lawyer, we had many clients who had lost their job because of health issues, and their healthcare costs had become unbearable. I would see broken people come in all the time under the weight of medical debt. We would help them file bankruptcy, back before bankruptcy “reforms” made filing much more difficult. We would see a significant difference in them before their hearing because their creditors had been under court order to cease collection attempts. If we had the chance to see them after their bankruptcy had been discharged, they were completely different people. Without the stress of debt, their health was able to improve.

I will never understand why people oppose healthcare reform. I’m not necessarily talking about socialized medicine, though I think it is needed. I just mean that doctors should not charge patients without insurance more than they charge patients with insurance because doctors negotiate with insurance companies. Many things need to be reformed if we are not going to move to universal healthcare. The state of the United States’ healthcare is dire, and too many people just can’t afford the healthcare they need.