When Health Care Can Endanger Your Health

So I staggered out of bed this morning at 4:30 to change the litter box and feed the cat because he was crying plaintively in the hall. At least for a change he wasn't climbing over me, but his crying was even more pathetic. I haven't exactly been neglecting him lately, but I have been distracted and he hasn't been getting his usual amounts of playtime and affection. I knew the box needed changing, and that he has fits about it when it does, but I was planning to do it first thing in the morning. Well, that's exactly what happened, only morning began a lot earlier than I'd intended. I've got to make a point of playing with him today.

These have not been good times, for a long time now. I've been worried sick because of the pet food scare, afraid I might have poisoned my beloved cat without realizing it. The apartment complex I live in converted to being a co-op, I've continued to rent, and the rental apartments were suddenly sold, without telling us, to a new investor. Those of us who rent have been scared out of our minds, unable to find out how to get necessary repairs, or even to whom we should pay our rent now. And as though that weren't enough, in the amount of time I've spent trying to arrange to get medical tests that were prescribed by my doctor I could have written the great American novel. What's been the hang up? Red tape and paperwork. I'm not kidding. If these tests do happen to be urgently needed, my doctor will be able to find out exactly what's wrong during my autopsy, I guess.

Naturally, there's a history to this. Last fall, my doctor prescribed a statin to lower my cholesterol level. Millions of people take them without any bad effects, but they can adversely affect the liver. He noticed after I'd taken them for a little while that my liver enzymes were elevated. I don't know whether he'd checked their level before I started taking them. After a few months I had a few other symptoms, he checked my liver enzymes again, and they were even more elevated. I'd had a CAT scan of my lungs for various dubious reasons I've reported elsewhere, and this indicated that I have gall stones.

Briefly, I had hystoplasmosis many years ago, very common where I was living at the time, I'd never had any symptoms from it, but my chest X-rays look awful. The only reason I need to know I'd had that is so that I could tell doctors who prescribe chest X-rays that I've had it so the X-ray won't alarm them. But doctors in this area have never seen a case of hystoplasmosis, and don't tend to listen to patients who try to tell them that this affects how their X-rays turn out.  He insisted that I have a CAT scan of my lungs, which showed that I also have gall stones. Luckily I was able to find a specialist who explained to him that I was a classical example of someone who has had hystoplasmosis, but there were also those pesky gall stones. When I had some symptoms that indicated a liver problem, he wanted to be able to make a differential diagnosis; was the statin I was taking causing the symptoms, or could it be that a gall stone was blocking my bile duct? That seemed reasonable, so when he wanted me to have a sonogram of my liver I agreed. That's when the fun began.

It took me 41 days, including several canceled appointments because the lab insisted it didn't have adequate paper work for my insurance company, for me to get the sonogram. If I'd actually had a blocked bile duct I'd have probably been in the hospital in agony by then, and I knew it, but the doctor told me to get a sonogram so I kept slugging it out between his office and the lab to actually get it.

As though that wasn't enough, after I'd had the sonogram, the doctor decided that I should have a CAT scan of my liver. I'm not entirely sure why; all he'd say was that the sonogram didn't quite resolve "something." Maybe a cyst. But, according to online research I've done since then, a sonogram is the usual way to diagnose simple cysts. In the back of my mind, of course, is the thought that I might have cancer. I don't at all like the idea of something unresolved by the sonogram on my liver. I'd stopped taking the statin as soon as the doctor suggested it might be causing me symptoms, and I've had no symptoms since then, which means I haven't had any symptoms for months. Except for the fear inspired by the request that I have a CAT scan, I've been feeling perfectly fine physically. Maybe he's being overly cautious, as was the case with the CAT scan of my lungs. I have no way of knowing in advance.

Suffering considerable Fear of Paperwork and Red Tape, I made an appointment for the CAT scan. I had to wait two weeks for the appointment. I can't describe how severe the Fear of Paperwork has been. It was vastly worse than any fear of the test results. I could barely eat or sleep, much less pay proper attention to my poor cat. The timing of this is terrible; my daughter in law is about to have a baby. If my poor son has to cope with a new baby and a mother with a terminal illness, I truly pity him. I HAVE to know what's going on in a reasonable amount of time so I can figure out how to cope with this.

So you can imagine my horror when the lab called the day before the CAT scan and canceled it, insisting they didn't have the proper paper work for the CAT scan. I'd have to wait another two weeks for the $#@# test! That's this coming Wednesday. I had no idea which office was at fault, and I'd have to do some rapid trouble shooting.

I did find out what the paperwork problem has been. The insurance company normally requires a pre-approval number for radiological tests. However, it has handed over the responsibility for this to a company called CareCore, which is supposed to evaluate whether doctors are prescribing unnecessary tests and procedures and save them lots of money. Of course this puts yet another, and very expensive, layer of red tape between the patients and the doctors. I know this because I once worked for an identical company that provides this same kind of service for dental insurance companies. I'm not sure we ever actually caught a cheating dentist, but we tried, and got paid very well. So maybe I'm now suffering some kind of Karma.

The problem turned out to be that the lab office kept insisting on that approval number, and CareCore kept telling the doctor's office that I don't need pre-certification to have the test. The lab office refused to accept that. When they'd call the insurance company they were told that the doctor's office has to contact CareCore to get the number. Naturally, since CareCore has decided that I don't need pre-certification, they wouldn't give a number! The manager of the doctor's office finally managed to get CareCore to put this in writing for her, faxed a copy to the lab, and mailed me a copy. Anyone want to place a bet on whether I'll manage to get that CAT scan this Wednesday?