Treating my (insert medical issue here): Insurance nightmare

When you have medical issues, it is not as easy as just picking up the phone and getting an appointment with a doc to get things “cleared up.” In my case, I have to jump through hoops with the insurance company.

The state of health care in this country has gone to shit. Not just in the treatment side. In the billing side too. I have a HMO. I pretty decent one to boot. I have zero deductible.  I have very low co-pays. I have very awesome coverage. However, I have to fight to get a referral. I have a shitty PCP. I have to fight to change the PCP. And my PCP wants to treat ALL my issues but there is a catch.

Well, there is more than one catch. 

I can only discuss one issue at time each time I come in.

They are all D.O.’s and are really not qualified to treat the lengthy list of issues I have. This is why I have to see specialists (as in multiple).  I will get to that in a minute.

Now on to the insurance issue. My insurance company (Blue Cross), is one that participates on the Marketplace to help people gain access to affordable health coverage. Due to whatever reason, a lot of my specialists stopped accepting Blue Cross over this last 12-months. I am having to find new specialists. This means asking my PCP for referrals.

Imagine pulling a tooth from an alligator. That would be so much easier. WAYYYY EASIER! But I digress.

Back to my PCP. My PCP has is not just one D.O. in the office. There are multiple. I never know who I am going to see and it about a four to six week wait to see the doctor. This even if you are very sick.  

When you are sick, they look at you like you are making things up. Then from a 20 minute conversation about your health, they diagnosis you with something that would require a much longer examination and by a specialist.

I will give you a couple examples.

EXAMPLE NUMBER ONE: HEARING LOSS – I went in because I literally was not able to hear. My hearing was significantly reduced in both ears. This is a cause of concern. It was steady getting worse. 

I was told “There is nothing wrong.” “We can’t find anything.” “There isn’t even an infection.” I kept on them about it. Finally I had enough. I started going to the walk-in clinic. I went every other day for two-weeks straight. I was not giving up.

I kept asking for a referral. “I NEED TO SEE A SPECIALIST! I NEED SOMEONE OTHER THAN YOU TO LOOK AT MY EARS! I CANNOT HEAR!” After two-weeks and my friend telling them, “she cannot hear. The TV has to be turned up to 30 in order to hear and she says ” what” a lot”, I finally got a referral.

Guess what the discovery was?

My eardrum in one of my ears was crushed from the blows to my head and it had a whole in it. I had severe hearing loss in this ear. I have conductive hearing loss in one ear and sensorineural hearing loss in the other. In both ears, the typmanic membrane was retracted.

I am deaf! 

But hey, according to my PCP, there is nothing wrong with me. UGH!!!!

EXAMPLE NUMBER TWO: I go to my PCP yesterday. Well, let me back up. I stopped taking (on my own) Keppra. That shit is for the birds. It seriously makes you into the Devil! That is for another blog post. Since I have been off the Keppra, I have thought much clearer. I have only struggled with word finding a few times. My insomnia is still there. But hey, it is better than not coming out of my room. I have a shit ton of energy. I have been able to accomplish a lot. I actually feel somewhat normal.

I still struggle with a lot of things cognitively speaking. However, that is something I am learning to deal with and have become accustom to unfortunately. I have my piece of paper with my LONG list of “I need referrals to” and “this is whats going on” in hand.

I had a melt down before we got to the doctor, so it was already a bad morning. THANK YOU JOSEPH DERISO for that one. 

I sat in the chair with my friend next to me because he sees what I go through and it is better to bring him with me so he can tell the doctor what he observes, than me just saying, “hey this is what is going on.” I tell the nurse first everything and she says, “you can only tell the doctor about one thing.”

Of course. Why address anything else? I mean, I am the patient and I have multiple things. I need multiple referrals since the doctors they sent me to no longer accept my insurance.

I told my friend previous to us getting there, “Just wait you will see what I go through at this doctor. Now you will know why my (I went down the list of things) isn’t being treated and they keep just upping the doses on medication I don’t need or want to be on.” The doctor comes in and I tell her all the thing going on.

I start with my hearing. “I need a referral to the ENT for another audiogram. My hearing is getting worse.”

She looks in my ears. “You have a lot of scarring in your right ear and..”

I interrupt her, “yes I have PE tubes.”

“How old are you?” she says, with a puzzled look on her face.

“44. My hearing loss, brain injury, the seizure disorder which from the brain injury, PTSD, Panic Disorder, depression, nasal and sinus issues, neuro-sensory disorders, back injuries, optic nerve injury, and neck injury are from domestic violence.”

I told her this with a look on my face that only be described as “you dumb bitch if you read my chart which is right in front of your face on the screen, you would have already known this.”

The tone in my voice was not one that was pleasant at all. I literally grit my teeth afterwards. I bit down on my jaw, locking it so hard that afterward I had a tension headache. My total visit with her, 15 minutes. Maybe 20 minutes max. I have access to the patient portal.

This includes the notes she puts in and her diagnosis for the day. I had told her about my cough for over a month. Not only did she diagnose me with yet another mental health diagnosis, she diagnosed me with bronchitis and didn’t bother telling me I had it; nor did she prescribe me anything.

Today I receive a phone call telling me she is taking me off my anti-depressant and putting me on Cymbalta. I asked for the side effects. The receptionist had zero clue. So I Googled them and reviews. Now mind you I just got back a lot of energy from a medication from HELL!

Lets go over the side effects.

Asthenia – abnormal physical weakness or lack of energy (sounds fun.. NOT)



dizziness – I have this already from my TBI. I don’t know if adding to it would be fun. I even told her I stand up and I experience dizziness every time. Hell, in my chart it says, “at risk for falls.”



hypersomnia – excessive sleepiness 

insomnia – I already have this



headache – I told her “I walk around with a rubber band feeling on my head. It is like a tension head but more like a migraine.” She told me it is the effect of my anxiety. Funny It didn’t happen until my TBI and even the neuro doc has stated it is TBI related. So lets add to it. 

xerostomia – cotton mouth. Oh joy one more medication that constantly makes me thirsty. 

 agitation – This is the EXACT reason, well one of many, that I stopped taking Keppra. No one likes a monster. 

nervousness – I am already a very jittery person due to my Panic disorder and anxiety attacks. I have lack of trust in everything and everyone. Why add to it? This is not a good medication for someone with PTSD. 

 psychomotor agitation – increase in purposeless physical activity often associated with depression and mania. Symptoms may take the form of restlessness, pacing, tapping fingers or feet, abruptly starting and stopping tasks, rapid talking, racing thoughts and ideas, meaninglessly moving objects around, and more. This is according to Well, guess who already does this? PICK ME! FML!!!!! I have a counter clicker, you know the thing that people use to count things, like people, that helps ease it some. But it isn’t 100%. 

tension – ha ha ha. Yeah already there. 


abdominal pain

anorexia – now I have read reviews that say otherwise. Every review I have read stated this a weight gain medication. I have zero thyroid. It was removed in 2008 due to cancer. I have issues with my back, hips, knees and ankles. Weight gain is not good for those joints. One of the issues is Degenerative Joint Disease; or osteoarthritis. My knee is bone on bone at this point. Extra weight would not be good. 

decreased appetite – barely eat now. 

decreased libido – from what Joseph DeRiso did, I cannot have intercourse ever again anyways. 

hyperhidrosis – excessive sweating. Oh lovely. Just lovely. 

restlessness – I am already like this. Why would I want to be like it even more?

So lets get this straight, this medication is supposed to help depression how? Oh it is going to turn me into a walking zombie who is nervous and one day sleep too much, while the next day stay awake all night and day but sweat too much while being super bitchy (Probably from the headache), physically weak, stressed out, stopped up one day and shitting myself the next. Sounds like a fun time.

Hey what will I know, I will be a zombie according to the reviews. And if I quit, it will HELL because I will be sicker than all get up. Yeah, I think I will stick with what I am on. I am good. I will wait till hopefully the new referral comes through and I can see this new doctor.

Who the Hell creates these drugs? Satan?!!?!?!?!?!?!?!