Under the knife…

So, tomorrow I go under the knife again for the fourth time in my life; this latest is what I hope will be the final volley in my endeavor to fix my sinus, apnea, and general breathing issues. In short, I’m getting a new schnoz…

Well, not really. Just a reworking of the scaffolding inside the schnoz; like the statue of liberty getting some new girders (as opposed to new garters).

And wouldn’t you know it, in my own Michael Moore moment, in the eleventh hour the insurance company has denied coverage for one of the three procedures that my surgeon was to perform. The “reason” given: “not medically necessary.” When I called said insurance company to inquire further, the physician who signed off on this did not leave any notes or further information as to how he/she arrived at this conclusion.

So, let me get this straight – a doctor who doesn’t know me, who has never met me or examined me, has determined what I need in terms of medical intervention. Welcome to the American insurance business…

And I can totally tell you that what’s at play here is a “one size fits all” approach to healthcare. Many people who are diagnosed with sleep apnea have gained weight or have obesity issues; that’s not the case with me (in fact, every person who has examined me along the way has always started by commenting that they are suprised when they see me in person after looking at my chart because I look like I shouldn’t be a candidate for apnea). Apnea is either neurologically driven or structurally driven; my sleep study showed that it’s structural, not originating in the brain, so it would seem to reason that if the structure is the problem, changing the structure could be a cure. I know of several people who were over-weight and through weight-loss were able to alleviate their apnea symptoms; as someone who is not over-weight, this avenue is not an option for me, but obviously trimming some of the tissue in the back of the throat could be. This is the procedure that the insurance company has denied.

They want the quick fix (which they think will be more cost-effective in the long run): you have apnea? here’s a CPAP machine, that’s how we “treat” it. Next!”

The CPAP is not a treatment, it’s a means of forcing pressurized air into the nasal cavity when the patient desat’s to the point of losing respirations; in other words (or to put it in terms that my brethren in the anti-violence movement can understand) it’s not prevention it’s intervention. This approach does not take into account the unique circumstances that could be at play with my particular biological, physiological reality as a patient. It does not take into account the reality of me (and by the way, I’m the paying customer; remember me? – I’m the one who is paying for your company to exist; I’m the one who pays your salary…)

So, if I should happen to survive the anesthesia and all tomorrow, I’m going to appeal this decision to the hilt. And assuming I am successful, this company, that was so concerned with saving a buck, will end up paying for surgery TWICE! I mean, never mind how angry I am as the patient, as a paying customer of this company, I’m appalled at the blatantly stupid decisions. This is going to end up costing us all more in the long run.

I think I’m going to buy Sicko for everyone on my X-mas list…

1 thought on “Under the knife…

  1. My advice would be to dump the health insurance and give yourself a sergical throat scraping at home. But I’m guessing that since I’m (classlessly?) late to this party my opinion is somewhat moot.

    Conversely, you probably don’t have to pay $100 for a 15 minute office visit with a family practice MD.

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