I'm Shocked

I had a voicemail from the Dr's office when I came home Wednesday night so I called them after I got to work Thursday morning.  Insurance actually approved the PA!  I was shocked that they did this and didn't require any further proof (i.e. the esophageal pH test) that I have GERD to continue covering Dexilant.

I'm hoping to eventually not need medicine on a daily basis. Everyone says losing weight helps, 25+ lbs. I lost 20 lbs last year and it obviously didn't do anything for my GERD symptoms. Hopefully the weight I lose on Weight Watchers will do the trick. I'm also going to look into taking aloe and/or papaya juice and digestive enzymes.

Typical....Nothing Seen on MRI

The doctor called early Friday afternoon after receiving the results summary.  As it typically is for me nothing showed to be irritating the trigeminal nerve.  The only thing that showed up was a little something in my left nasal sinus cavity.  UGH!  Now Benny says we're not going to do any more special tests like this since they're not showing anything the doctors can use to figure out what's wrong.

I got the authorization confirmations from insurance afterwards.  The doctor's office said they ordered a MRI with contrast but both confirmations said without dye.  So I have a feeling we'll have to pay more for the usage of the dye...receiving the bill just in time for Christmas.  Just what we can't afford right now.

The doctor also said she finally got the information fromt he neurologist for possible alternatives to the Tegretol.  Since I'm no longer experiencing pain there's no need to continue Tegretol or try the alternatives.  I hope she put the information in my file so we'll have something to turn to if/when this comes up again.

The Results are In

Well, I went to the followup appointment and the fellow was going over the results when she spotted an error in the day study data.  The doctor had made an error in a calculation "in my favor" that resulted in correcting the diagnosis to something like "excessive sleepiness."  Still that means there's not much that can be done about it.

The doctor said if we go the medicine route we wouldn't be able to continue trying to have kids; she didn't want to be responsible for someone having kids with horns!  I checked out the medicines she discussed (Nuvigil & Provigil) and they both say to tell your doctor if you are pregnant or are planning to become pregnant and to talk to him/her about birth control.  That idea turned Benny off.  He wants a kid of his own and he's not getting any younger.

I called St. Francis' weight loss program and asked about how they work around the insurance coverage issue.  They woman that answered the phone didn't have a friendly tone.  She told me that the initial visit, testing and lab work is $2300.  There are 10 followup visits which are $100+ each.  So that's another option that I can't do.

Next I called IU's program to find out if I should still be on the waiting list.  We played phone tag a few times before I was able to speak with someone.  This woman explained that they bill visits as regular doctor visits so that would covered by insurance.  So this sounds more promising despite the hiccup with them not accepting new patients for the program yet.

Sleep Study III - Done

Despite my normal bedtime being around midnight they had me arrive at 8pm.  I was wondering what all I would do for 4 hours.  Mostly I flipped through all the tv channels, stopping to watch something for a few minutes and then moved on.

After I was in the room for maybe an hour the night tech hooked me up with all the wires.  Some of the leads itched or burned but nothing actually burned my skin this time.  I asked for water to drink and she gave me one of those mini bottles (which surprisingly lasted me through the night).  Around 10:30 pm she put me down for the night.

Throughout the night I woke up with all my joints aching from laying funny to avoid accidentally removing leads.  Once I woke up hearing a lot of movement and conversations in the hallway I assumed it was sometime after 7 am.  However, when she unhooked me so I could go to the bathroom, she told me it was about 3 am!  I felt awake but not fully alert (or maybe the other way around) so it took me a little bit to go back to sleep.

When waking again later I heard less movement but still conversations in the hallway.  This time it was 7 am so I was done for the night.  The day tech unhooked most of the leads and brought me juice and granola bars (what I normally eat for breakfast).  About every hour and a half she returned to hook me up for the 20 minute naps.  I never was completely asleep but dozed a few seconds, waking up when I started snoring.

The last nap was at 4:30 pm.  I don't recall the day study taking this long on the other two studies.  I stood in the shower what felt like a long time to get the goo out of my hair.  I think most of the goo came out before applying the shampoo.

When I got home the insurance approval letter was waiting for me in the mail.  The letter was dated Monday so why did it take until Friday to reach me?  Talk about slow processing time!

Insurance Approved!

I called insurance Tuesday for my annual verification that nobody has other insurance.  Once that was done I asked the rep to check on the pre-authorization for the sleep study.  She said it was approved but no number had been assigned (whatever that meant).

A few minutes later I received a call from the sleep lab saying she had just spoken with insurance and said that they had approved the sleep study.  That night I received an automated reminder message about the sleep study.  Wednesday morning I received another call (from an actual person) verifying the apointment.  Wednesday evening, while out to dinner for Benny's birthday, I received yet another automated reminder message bout the sleep study.  Talk about overkill!

Tonight is the night so no more reminders (I hope).  I'm to check in at 8pm but usually don't get to sleep until around midnight.  So I hope that I'll be able to sleep earlier otherwise I'll run out of things to do quickly.  I'll be there tomorrow until who knows when where they check to see how easy it is for me to doze during the day.  I don't recall if I nodded off during this portion on the other two studies.  There's a higher chance that I will doze this time (or so it feels like).

Not Covered by Insurance

Dear Valued Member,

We have received your Internet inquiry regarding weight loss programs. This service is also not covered under the plan.

So, I don't know how they get around this when billing the medically supervised weight loss programs. I can't afford to pay for services out of pocket.

Although IU's program is currently full St. Francis isn't.  If there's a way it may be through them instead.

The sleep study is still pending....

Insurance Pended

We have received a request to approve the services identified above (the sleep study).  However, at this time we do not have enough clinical information regarding your health status to determine whether the services are covered by your plan.

If you and your physical decide to continue with the treatment, we cannot guarantee benefits will be covered.

In order to process your request the following information is requested:

• MD office notes and exam findings
• Diagnostic testing results
• Previously tried treatments and medications
• Any other information you feel would support this request
• Does the member have narcolepsy?
• Is the member suspected for idiopathic hypersomnia?
• PLEASE USE ATTACHED PROVIDER TOOL (wasn't attached to my copy so I hope they put it with the doctor's copy)

We have 2 business days to complete your request after you provide us with the additional clinical information.  If you do not provide us with the additional clinical information that has been requested, we will review by 06/20/12 based upon the information you have provided thus far.

So I've sent a message to the sleep doctor's office asking if they needed anything from me to help get this processed.  I hope a rush is put on this so a doctor can find out what's wrong with me and get a workable treatment plan.  I'm tired of being tired....10 years is too long!