Sports Illustrated, other diagnostic tools vs. the Insurance Company
In the late 1970's I started developing vertigo and some fatigue to a level that caused problems with driving long distances and it would interfere with my daily activities. I have always had jobs that required me to work 60-80 hours per week and initially it was just an inconvenience. A few years later, it became worse and I had extensive tests that, at the time were sophisticated and came up with nothing. Therefore, I was tentatively diagnosed with Chronic Fatigue Syndrome. This was really a diagnosis by default since no one really knew what was causing my problems.
On one visit to my family physician, a nurse mentioned that there was an article in Sports Illustrated about using IgG injections for helping with CFS. The doctor was open to trying it and over a period of 4-6 months, I was improving. I really don't have CFS, but, a few years later, my current Primary Care Physician had my IgG tested and it was very low. Some of the symptoms are fatigue, chronic infections among other things.
Because of such a serendipitous chain of events, I found out what was causing my problems. Although I seem to have a lot of appointments, I really don't want to spend time going to doctors; I just want to function well. So, a specialist suggested IV IgG infusions.
Enter the Insurance Company: I did not expect the initial injections to be covered, so I paid. Later, after tests and a diagnosis came through, I assumed that the injections and maybe even infusions would be covered. It was denied, appealed, and denied again. So, I continued to pay myself since I knew they were the solution. Unfortunately, without the infusions, my IgG was low enough that I still had infections and multiple rounds of antibiotics (which were covered). It took about 10 years of this until my "Patient Advocate" at the Insurance Company called me and said that they were concerned that I was taking so many antibiotics and wanted me to see a Hematologist. I told them that the Hematologist had sent letters to them explaining that until my IgG levels were increased, I would continue to get frequent and hard to treat infections. Also, I mentioned that if they were that concerned for my health, it would be nice to cover a few infusions to eliminate the problem and I would be happy to talk to "The Guy" They never called back, so the concern seemed a little short-lived and probably profit motivated because of the costs of antibiotics. I know that some companies did cover the injections because of the health/cost benefit. I told them about the studies at Mayo Clinic, but didn't feel that Sports Illustrated article would have the same clout.
There are 3 things that I learned through this process:
1. Some insurance companies are short-sighted when dealing with costs. Had I had the infusions 15 years ago, they would have saved 90% of the costs of doctors, tests and medication. In addition, many of the problems that I have today are directly attributed to the lack of IgG.
2, We should not go crazy with appointments, but periodically check back with our Primary Care Physician to try to keep functioning. Keep an open mind about from where the answer will come. Without the Sports Illustrated article, I may have had to wait until actual medical tests were developed to find out what was causing my problems.
3. If I am willing to personally pay for any medication or procedure, I guarantee you that it is helping me. Unfortunately, there has been far too much of that going on. Regardless of what insurance companies and some politicians say, many patients really are aware of what medications and procedures cost and will attempt to be good stewards with the money spent because they are the ones that deal with that problem every day.
TVP
Email The Virtual Patient
On one visit to my family physician, a nurse mentioned that there was an article in Sports Illustrated about using IgG injections for helping with CFS. The doctor was open to trying it and over a period of 4-6 months, I was improving. I really don't have CFS, but, a few years later, my current Primary Care Physician had my IgG tested and it was very low. Some of the symptoms are fatigue, chronic infections among other things.
Because of such a serendipitous chain of events, I found out what was causing my problems. Although I seem to have a lot of appointments, I really don't want to spend time going to doctors; I just want to function well. So, a specialist suggested IV IgG infusions.
Enter the Insurance Company: I did not expect the initial injections to be covered, so I paid. Later, after tests and a diagnosis came through, I assumed that the injections and maybe even infusions would be covered. It was denied, appealed, and denied again. So, I continued to pay myself since I knew they were the solution. Unfortunately, without the infusions, my IgG was low enough that I still had infections and multiple rounds of antibiotics (which were covered). It took about 10 years of this until my "Patient Advocate" at the Insurance Company called me and said that they were concerned that I was taking so many antibiotics and wanted me to see a Hematologist. I told them that the Hematologist had sent letters to them explaining that until my IgG levels were increased, I would continue to get frequent and hard to treat infections. Also, I mentioned that if they were that concerned for my health, it would be nice to cover a few infusions to eliminate the problem and I would be happy to talk to "The Guy" They never called back, so the concern seemed a little short-lived and probably profit motivated because of the costs of antibiotics. I know that some companies did cover the injections because of the health/cost benefit. I told them about the studies at Mayo Clinic, but didn't feel that Sports Illustrated article would have the same clout.
There are 3 things that I learned through this process:
1. Some insurance companies are short-sighted when dealing with costs. Had I had the infusions 15 years ago, they would have saved 90% of the costs of doctors, tests and medication. In addition, many of the problems that I have today are directly attributed to the lack of IgG.
2, We should not go crazy with appointments, but periodically check back with our Primary Care Physician to try to keep functioning. Keep an open mind about from where the answer will come. Without the Sports Illustrated article, I may have had to wait until actual medical tests were developed to find out what was causing my problems.
3. If I am willing to personally pay for any medication or procedure, I guarantee you that it is helping me. Unfortunately, there has been far too much of that going on. Regardless of what insurance companies and some politicians say, many patients really are aware of what medications and procedures cost and will attempt to be good stewards with the money spent because they are the ones that deal with that problem every day.
TVP
Posted by The Virtual Patient at 3/18/2009 9:45 PM 
Categories: Irony,Patient Responsibility,Insurance,Appeal denial
Tags: Patient reasonable and customary Appeal Insurance healthcare irony cost
Categories: Irony,Patient Responsibility,Insurance,Appeal denial
Tags: Patient reasonable and customary Appeal Insurance healthcare irony cost
The doctor was open to trying it and over a period of 4-6 months, I was improving. I really don't have CFS, but, a few years later, my current Primary Care Physician had my IgG tested and it was very low. Some of the symptoms are fatigue, chronic infections among other things.
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