Insurance Companies Love to Get Between You and Your Doctor

One of the big arguments against socialized medicine is that it puts the government between you and your doctor. I find that puzzling because insurance companies already are there. And an insurance company is a for profit entity that 100% does not want to pay for stuff your doctor orders. Every visit, procedure, or medication reduces their profits after all.

We’ve experienced many denials by our insurance company dealing with Ani’s health. Apparently figuring out what is wrong with her and treating her wasn’t actually medically necessary. Or so you would think if you just listened to them and how often they overrode her doctors.

My doctor had to make a huge case for me getting the pneumonia shot “too young.” Eventually, with lots of evidence provided that I’d had bronchitis and/or pneumonia at least once per winter AND wasn’t immune to most strains included in the shot, the insurance approved of me getting the shot. Considering I didn’t get any respiratory infections this season for the first time in years, I’d say my doctor was exactly right even though the insurance company didn’t agree at first.

Well now we’ve hit yet another time the insurance company is getting between my daughter and her doctor. She has been on Lyrica for four years. In August, the insurance company changed from covering the brand name to the generic. It was a little annoying since we were paying $4/month for the name brand thanks to a co-pay card and have to pay $60/month for the generic. But whatever.

Well, it turns out the generic doesn’t work as well for her. She’s feeling the electrical impulses coming from her spine like she did pre-Lyrica. She’s in a whole lot of pain like she was pre-Lyrica. She’s constantly in a flare like she was pre-Lyrica. So the doctor ordered brand name only for her.

We went to pick it up and it’s $795 a month. The insurance company said we can’t appeal since it’s not a denial. They just aren’t covering it. They said she is welcome to keep taking the generic (which doesn’t work) or switch to something else, but unless we want to pay almost $800 a month Lyrica will not be what she takes. So she called her doctor and is leaving it up to him what to do next. Hopefully the insurance company won’t have a problem with whatever that is, too.

Update on Ani’s Health

It’s been almost four months since we started getting diagnoses for Ani. At that point, she was sleeping up to 18 hours a day and worn out all the time. She was so incredibly sick.

What’s wrong with her: Ani has Ehlers-Danlos Syndrome, POTS, Fibromyalgia, and Celiac Disease.

What we’re doing to treat her: Every day Ani takes a beta blocker to help control the racing heart from the POTS. She did an experiment trying various POTS remedies and found that Nuun electrolyte tablets work best for her. She takes one in the morning and one in the evening now. She takes Lyrica for the Fibro pain. Recently she had to up her dose because the drilling pain that she now knows is from the fibro started up again. Hopefully, we’ll be able to decrease it back down in a couple weeks. She is careful with her range of motion to avoid EDS pain and, of course, she eats no gluten so the Celiac is usually a non-issue. She has been going to physical therapy for her neck (side effect of the EDS) and that pain has decreased a whole lot, enough that she no longer takes Aleve regularly. She is getting better at watching her body temperature (she has trouble regulating her body temperature because of the general dysautonomia that includes the POTS).

So how is she doing?

Amazing.

She’s still so incredibly sick, but when I think of how my daughter was just a few short months ago, the difference is incredible and so encouraging. I’ll be honest. I did not think she would survive. She was getting worse and worse. I thought she was going to die. She thought she was going to die. It was bad.

In March, a friend asked if they could dedicate their monthly fast to Ani’s health. Her whole family fasted for Ani. She encouraged others to do the same. I will always believe that changed everything for my daughter. It was within days that we started getting answers. We found doctors willing to help instead of brushing her off. We got medication, we got a treatment plan to help her, we got diagnoses.

She still has bad days. Some are very, very bad. On the Fourth of July, we had a church picnic. It was hot. We live in Texas, after all. She got overheated. Getting overheated means she got sick. Very sick. She slept most of the afternoon/evening that day. The big difference is, though, that the next morning she got up and was functional. She didn’t need three days to recover. That is a miracle. She still gets exhausted relatively easily, too, and she never feels truly good. But it’s livable.

Over the last week, she spent several days being a substitute nanny for three little girls and still did her normal program directing at taekwondo and also babysat a little girl Friday night. These are things she literally couldn’t have done just a few months ago (though I think she might sleep most of today since she was so exhausted by last night). She’s got plans to go see Spider-Man with one friend and Wonder Woman with some other friends. She’s training at taekwondo and working toward her second degree black belt again. She’s actually being able to be a human. Most importantly, she has hope for a future. A sometimes painful, taking medication for life future, but still a wonderful, full, happy future.

We Have Some Diagnoses!

We already knew Ani had Celiac Disease and insomnia. She was diagnosed with POTS last month. We finally got a copy of her upright MRI report. It was not good. She does not have Chiari, but she does have a totally jacked up neck. She has mild straightening of the neck, a 2mm subluxation at C4, multiple herniations C4-7, and narrowing of the cerebrospinal fluid space.

Yesterday she saw her rheumatologist. He is a soft-spoken, kind man. He read her MRI report and looked at her and said, “You are in pain.” He sympathized with what she has been through and promised he will help her get well.

So he added two more diagnoses. She has Ehlers-Danlos. It is likely many people in our family – including me – have it mildly. She’s having a lot of pain because of it because her joints are constantly going out of place. Her hips and shoulders are misbehaving the most lately. For that, she is to continue taking Aleve and use wraps, K-T tape, etc. She is also to do isometric exercises to help “teach” her muscles where to stop rather than allowing them to keep going as far as the joints will let them.

She also has fibromyalgia. For that, he prescribed Lyrica and wants her to do some gentle exercising every day. One day she’ll get back to training at taekwondo, but we need to fix her neck first. It makes sense that the Aleve was helping some, but not everything. Her fibro pain isn’t from inflammation so the Aleve was only good for the EDS pain and possibly her neck pain.

He said she really needs to get deeper sleep. We have noticed that when her pain is high she can’t sleep but when she can’t sleep her pain gets worse. It’s a vicious cycle. When her pain is really high she ends up with muscle twitching. So to help with the sleep, she is to take Benadryl every night. It is the only thing that will reliably knock her out. Melatonin doesn’t work for her and we tried Aleve PM and while it made her tired, she still sat staring at the ceiling until well past midnight every night.

On Tuesday she will be seeing the neurosurgeon to decide what to do about her neck. This has been a long, hard road to diagnosis. It is such a relief to finally be making concrete plans for helping her to live a normal life with limited pain.