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June 13, 2005
Utilization Review Boards
The day never really got any better for me. I feel totally whacked out. My head feels like it is buzzing somewhere in orbit around Earth, my lower body feels heavy and burdened, my stomach has been nauseated but I don't feel sick. I feel like I'm detoxing actually but that's impossible because my diet hasn't been up to par, I've had wine and chocolate. I've promised myself mat time tomorrow even if I don't feel up to par. I can get away with excusing myself for two days with my moon for an excuse but anymore than that and I can't do it. I have to say though that I know something is going on because not only did I not practice today but I also have not once stretched today... truly unheard of for me. I'm talking nary a forward bend while cooking, watching the kids, etc. Bizarro World.
My tattoo is itching like you wouldn't believe. It's so tiny how could it itch? My new theory is that it is itching because I can't shave that portion of my leg and the hair growth itches. Yuck.
I got an email from the surgeon this afternoon... no answer. The surgeon has decided that our plan of attack should be that we both call everyday under the assumption that the squeaky wheel gets greased. Of course, they call and get to talk to people somewhere on planet of Utilization Review Board.... I call and I get to talk to the people swirling around in the abyss known as customer service. Of course every single customer service representative that I've spoken to gives me a new and different story. Today, the lovely Brenda told me that, according to my plan, I don't need authorization. I'm sure she heard me laughing all the way in New Jersery even without a telephonic mouth piece. Once questioned further she recognized the outstanding pre-certification request and informed me that the request had only been submitted on Friday. I let her know that, in fact, the request has been outstanding for quite some time and that the Utilization Review Board requested additional information on Friday which my surgeons provided within an hour. After being put on hold for 5 minutes she came back to the phone to acknowledge that, indeed, "there are a ton of notes" on my file. Really? I can't imagine. Near tears I hung up with her. I noted her sympathy as I was hanging up and she told me she understood but she could do nothing for me other than read the notes, I was not allowed to be passed over to the official offices of the Utilization Review Board because, well, I'm just a member. A few minutes of frustration later and I found my ovaries again. I called back, getting the fortunate Linda (whom I had spoken to on 6/1 as well) and explained the situation. In addition I explained that I was so very tired of having to call customer service and getting a different answer everytime I called and that what I really wanted was some sort of patient liasion who would assist me in working through this vast intricate network of the Utilization Review Board. Linda left for awhile to check my plan's allowance for a "case manager" (nice to know one's plan needs to include coverage to have someone actually work with you on your medical necessities) and when she returned she informed me that, yes, I did have coverage for such an entity as a case manager but that the request for a case manager would have to go through none other than the Utilization Review Board. Does it seem back-assed to anyone else that in order to find someone to help me make sense of the Utilization Review Board which is currently deciding the fate of my breasts that I have to go through the same board in order to get approval for such a person? So then the debate raged -- well if I ask for this, will that put off them making a decision about the mastectomy? If I ask for this will they see my name twice and know I'm a squeaky wheel who means business? If I ask for this will I be an annoyance and they'll deny me out of spite? In the end, I told Linda, to please submit whatever was necessary and she assured me a phone call back tomorrow.... I probably needn't say that I'm not holding my breath.
I'd like to say that I'm despondent and without hope but how can I be. On the one hand, with a surgery date within weeks, I have to maintain the mental outlook of a person who is choosing to have preventative mastectomy because I have to prepare myself for that eventuality. On the other hand, I'm also having to prepare myself for a denial of services by my insurance company... it's like being hot and cold at the same time. I have no idea which way to fortify my heart, my soul or my willpower. I have no idea which way to look, up or down, in or out. I just hope that whatever person is sitting there with my file making the decision recognizes that I haven't wished this for myself. I wish I was like the other "regular" women in the world who don't have to live with the hereditary fear of this disease or like those who are so new-aged out (nothing against them, I wish I had that blind faith at times) that they believe the power of the mind is enough to fight the genetics... but, I'm not.... and what I am is a woman who is at the end of a long rope and doesn't know whether to keep pulling up or simply let go. I'm a woman who has chosen a daring and drastic path in order to live with peace for myself and my family... the last thing I need is to worry about this mess we call insurance in this country... and, yet, here I am... another number... another anonymous Jane Doe with a file of notes sitting in front of some person who may or may not have medical training and who is more worried about the bottom line financially than about my long term health or sanity.
In good news, I decided today that even though I can't afford it at all I made reservations at The Fairmont Scottsdale Princess for myself and the kids for a couple days in two weeks. We're going to go and relax by the pool, hang out in our room, check out the waterslides, fish in the catch and release children's fishing lagoon and otherwise gel out, just the three of us at a luxury resort (okay, okay, in the hot ass Arizona heat of summer but whatever). I just need to look forward to something...
Posted by ashtangagirl at 7:07 PM | Comments (2)
Wierd Temperature Fluctuations
Yesterday I decided not to practice because it was the first day of my moon and I'm not having such a good one this month. I did something yesterday I haven't done since before having kids...that makes 7 years... I literally stayed in bed all day. I got up, showered, then laid on the bed watching lame ass reality TV (America's Top Model marathon on one of those channels that does that) and reading various books. The Husband took The Kids to his father's house (he does this every other Sunday but usually I'm at yoga the whole time they are gone) and then grocery shopping (he does all the Trader Joe's shopping, I do all the organic shopping at Jimbos) so I had most of the entire afternoon alone. It was wierd... but just what I needed as my body felt lifeless. Going to bed last night I set the alarm clock and woke up this morning at 5:50... this seems to be a pattern, getting up at 10 to 6 which is cool because that means my body is getting used to this early morning thing. I woke up, fooled around in my brain for awhile and decided not to practice. I'm glad I didn't. I don't know what is going on with me other than just a really bad moon day. My temperature is going haywire, I'm like feverish with no fever, my legs feel like they might split under me, my brain is barely coherent and I'm physically in some pain. I don't feel sick at all, The Husband says I'm not hot as in a fever at all. Maybe it's pure stress coming out of my skin?
I got an email from the surgeon's office this morning... the "case" is out with the medical director of the insurance company. Everyone keep all your positive thoughts going out into the universe as he's supposed to make his decision by tomorrow afternoon.
Posted by ashtangagirl at 9:13 AM | Comments (1)