Winning...and Losing

I finally heard back from the insurance company...and I won my appeal!  Hooray!  The final $12,000 of bills should be paid by them this month.  What a relief.  Their letter said they reviewed my case and found an "inconsistency in payment history."  I don't really care what they call it, I'm just glad they are paying it.

My submission to them included a 6 page letter that outlined my struggles with headaches over the past 14 years, how I came to choosing a nerve stimulator, and how it has changed my life.  I also included an outline of the documents I had received from them and how they were incosistent.  Altogether I submitted about 20 pages of documentation.  I guess that did it.  I was told that appeals received from patients (as opposed to medical professionals) are taken more seriously.  That's something to keep in mind if/when you ever deal with an appeal of this sort.

On a separate note, I also wanted to apologize to those of you that have contacted me recently that I have not gotten back to.  My oldest dog was sick the last few weeks and I had him in and out of the vet every few days.  Last Thursday he lost the battle and we had to put him to sleep.  It was very hard but the vet came to the house and made the experience as minimally traumatic as possible, I think.  It's amazing how deeply animals can touch our lives.  That dog was my companion for the last 12 years and although everyone thinks their dog is the best, he was truly exceptional.  It's been a long time since I've lost anyone or anything close to me and I forgot how hard grief is.  Anyway, I haven't been much in the frame of mind to be social but I will get to your emails this weekend.

Chatroom!

I've added a chatroom to the blog...finally!  I hope this will allow some of my readers interact with each other and share their stories instead of just me blabbing at you about my story.  Originally I had wanted to add a forum where conversations could be saved and users wouldn't have to be online at the same time but that's not an option with blogger.com.  There are, however, archives kept of anything anyone types in there so I think that may serve the same purpose.

To find the chatroom, just scroll to the bottom of the page.  It should appear below the  posts. You have to make an account with chatroll.com to use it (sorry!) but it's free .  I think the easiest way to use the chat is to make it a pop-out.  That way you can stay on there while you surf other websites.  To do that, just click on the icon in the bottom right corner that looks like this a box with an arrow coming out of the corner.  You can also go to the chatroom page, which takes you to the chatbox in a webpage layout, if that makes sense.  To do that, click the icon that looks like a blue circle with a green dot in it.  This chatroom web page is also where you can find the chat archives.

Enjoy!

Also, on a separate note, if anyone wants to do a "guest post" about their ONS experience, please let me know and we can certainly arrange that.

Battery Placement

I want to talk a little bit about battery placement as I've had quite a few discussions with people about that recently.

My battery is in the right side of my chest, just below my collarbone.  When I was discussing the stimulator with my surgeon we talked about battery placement.  I didn't really want it in my chest, as I thought the battery would be very obvious and the scar would be more visible.  I suppose this is true, but he told me that having it in my chest is better than having it in my low back/upper buttocks where a lot of surgeons place them for the following reasons, which all made sense to me:

1. It takes about 3 times more wire to run the battery down to your lower back, as opposed to your chest.  More wire means a longer surgery, more disturbance to your body, and a longer healing time.
2. When they put the wires down your back, they go through muscle.  When they go do your chest, they don't go into the muscle, or if they do, it's very minimally.  If you know anything about muscle, it takes a long time to heal, which means having wires runs through it increases your recovery time substantially.
3. There is a lot more movement through your back than there is through your shoulders/chest so with the rear battery placement, the potential to pull your wires loose is much greater, which of course leads to one (or more) revision surgery(s).
4. Charging the battery and using your remote is awkward as it is...having that battery in a place that is hard to reach and hard to see makes using it that much harder (in my opinion).

Speaking to people that have had their batteries placed in their lower backs, I find all these things to be true.  Yes, I have a more visible scar but my recovery was easy compared to what some others have been through.  I've also heard of doctors wanting to put the battery under your arm, but that was a discussion I never had...it was never brought up as an option for me.  I can't imagine having it there...I think it would be terribly annoying!  Therefore I think discussing battery placement options with your doctor is very important.  And if the scar on your chest is the biggest thing holding you back, just remember that it becomes a conversation piece, a way to educate others about headaches and the available treatment options.  Or it can make you look like a badass if you make up a story about how you got in a wicked bar fight.

Relief

I'm happy to report that I'm feeling much better now.  Monday was the last of the really bad days.  Between the stimulator, ibuprofen, and caffeine, I've been able to keep the pain to a minimum all week.  I went to work (and was productive!) and rode my horses.  The only weird thing is that I'm completely exhausted.  I don't know if it's from battling pain or from the medications I pumped myself full of last weekend.  Oddly enough, I think it's the medications.  It sure makes me wonder how I ever got through YEARS of taking all those drugs.

The Worst Week Yet

This past week has by far been the worst one since I got my stimulator last June.  A headaches suddenly came on last Monday afternoon.  I thought it was because I hadn't really eaten all day or because I hadn't had any caffeine after drinking a lot more of it than usual the week before (I was at a meeting all week...had to stay awake somehow).  The stimulator didn't work so I went home, took my Zomig, and went to bed.  Thought it would be okay but I was down all the next day, taking more Zomig along with ibuprofen, which often helps.  I felt a bit better on Wednesday, went to work but still ended up taking my Zomig halfway through the day.  Same story the next few days.  Yesterday (Sunday) I got to the point where I dug out the Vicodin I still have stashed away and took some of that just to try to break the pain cycle.  It worked for a few hours but that's about it so that idea didn't work either.

I know I really shouldn't complain too much because the pain really is nothing compared to what it was last year at this time.  I mean, I'm still able to work for the most part, and I was able to go do a few things this weekend.  But I guess I've just gotten so used to not having pain that I'm now spoiled...if living without pain can really be considered spoiled.  I think it's sad that it is.  Anyway, I've had a few bad headaches (about one a month) since I got the stimulator but I've never had one drag out like this so it's frustrating, and honestly a bit scary.  My mind starts playing that "what if" game:  What if the stimulator doesn't work for me anymore?  What if I go back to all those medications and doctors?  What if I have to have more surgery and more wires?  I try not to do that, but sometimes it's hard not to.

Maybe it's time to go back to some physical therapy...massage, acupuncture, etc., to try to keep these headaches under better control.  Or maybe I just need to move somewhere that has more consistent weather!  Sometimes I think all these spring storms moving in and out affects me.  I hear Costa Rica is nice...

Insurance Update

After my post last month regarding the insurance issues (to put it nicely), I made a LOT of phone calls.  Surprisingly Medtronic, the company that makes the stimulator, jumped right on it and said they would start an appeal case for me.  I didn't even have to do anything!  Talk about good customer service...that company is tops.  I hadn't heard from them in weeks and decided that no news was good news, but then they called the other day.  The rep told me that they had tried to appeal my case but since my other doctor (surgeon) had already appealed it 3 times unsuccessfully, appeals had been exhausted and there was nothing Medtronic could do, so they put the issue back in my hands.  However, the insurance company did tell them that I could submit an appeal myself, and that personal appeals from patients usually weigh in a bit heavier than appeals from doctors (yeah right).  So I am supposed to write them a letter and put everything in it...my history, prior treatments, stimulator experience, and of course why I feel they should pay, including any paperwork I have.  This all seems silly and redundant to me, since I had to give them most of that to get the darn thing approved in the first place but whatever, I guess it's better than dealing with a lawyer.

Being long-winded as I am, I decided that if they want everything, I'll give them everything.  I've already begun writing my appeal and have 5 pages.  I have a feeling it'll be at least 10 by the time I'm done.  They want paperwork?  They'll get paperwork.  I have a lot of it.  Plus I'm a government employee and we are masters of paperwork.

I have a feeling this might turn into a long battle, but I'm ready to fight it.  I still stand by my assertion that $12,000 is nothing to an insurance company, but it's a lot to me and therefore this is worth the effort.

And people think we don't need healthcare reform in this country...

Insurance Woes

One of the most common questions I get from readers is regarding insurance and how to get coverage for your stimulator.  Mine was easy enough...my doctor's office did all the pre-approval work.  But it looks like I jinxed myself by bragging about how lucky I have been to have great insurance to cover my stimulator.  Last week I got a letter in the mail from the insurance company saying they were denying over $12,000 worth of claims.  I had no idea what they were talking about so I just set it aside.  On Tuesday I got a letter from the surgeon's office saying they'd tried submitting my claims several times but the insurance company refuses to pay so it is now my responsibility.  Fantastic.

The charges they don't want to pay for are specifically for the stimulator.  They already paid everything else, including all the hospital costs, as well as many of the surgical costs.  I don't understand how you can pay for 90% of a surgery but not the other 10%.  Don't they do hand-in-hand?

I'd like to know why I sat around waiting for pre-approval for 6 weeks when that approval apparently means nothing.  On the positive side, I have all the paperwork to back up what I say.  On the negative side, I'll have to get a lawyer and go to court to fight this.  $12,000 isn't much to an insurance company so I am hoping they will settle out of court but still, it's going to be stressful to deal with.

I guess I should be happy they covered ANY of the surgery, since it seems like so many companies won't.  But still...the whole thing is really pretty annoying.  I haven't even seen or paid any medical bills in months; I thought this was all resolved.  Grr.