Seems like I have begun an odyssey of trying to navigate the US medical system – again. I’m going to try to create a timeline mostly for myself so that I do not forget how long it has taken. I don’t know the results yet and this is on-going.
In June of 2024 I went for usual bloodwork/urine testing at my normal doctor in Pelham, AL.
On July 26, 2024 we had the office visit where I explained to my doctor that I have had a racing heart rate. Simply by waking up and going to the bathroom would put me in the 130bpm range, which is crazy. She recommends that I go see a cardiologist just to be safe and recommend that I go to her own cardiologist. So I make an appointment in early August. The day before the appointment, the cardiologist’s office calls me and say they don’t take my insurance. I had to cancel the appointment. I have BCBS (Blue Cross Blue Shield of Alabama) which is a farily normal and widely used insurance here in the US. I call around and finally get an appt at HeartSouth, which is sort of right across the street near Shelby Baptist Medical center in Alabaster, AL.
08.29.2024: Office visit with Dr. Segrest at HeartSouth where they gave me a drug to lower my heart rate. This drug works, however the heart rate is still unusually high for the activities I’m doing. He schedules some tests for early October but first I must wear a Holter monitor for a week. I do this and then mail it back to HeartSouth. As of October 18, 2024 I do not know the results of the Holter monitoring
9.19.2024: My doc called me to say she she thinks she might have found out what my problem is by examing the urine test more. She found an abundance of metanephrines. This can mean an adrenal tumor (benign or less likely cancer) and along with my elevated heart rate. It really does sound like this was my problem. She gets me an appointment at the imaging center at Shelby Baptist (again, almost right across the street from where I live) for October 1, 2024. She wants an MRI and CT scan of the abdomen. She still wants me to do the tests the cardiologist has scheduled.
10.01.2024: The imaging center at Shelby Baptist calls me and says that my insurance was denied at their facility for the MRI & CT scan. I call my doctor and ask her what to do. She calls and says that it wasn’t that they didn’t take my insurance but that the MRI & CT scan had been denied by BCBS by some pediatrition (a doctor for children)- so she resubmits her request to the facility. Meanwhile, I get a letter from BCBS dated September 30, 2024 that reads:
A Carelon MD, board-certified in Pediatrics, has determined that this request is not medically necessary for the following reason: Your doctor told us that you have a fast heart rate and an abnormal blood test (high triglyceride level). Your doctor ordered a CT scan of your abdomen. A CT is a way to take pictures of the inside of your body. A fast heart rate and abnormal triglyceride leveles can be present due to various conditions… Based on the information we have, this test is not medically necessary.”
Interestingly enough, there was no mention of the high metanephrines level in the urine which is what my doctor was concerned about. Also, what is Carelon? I have BCBS insurance.
In about a week, my doc calls me again and says that the CT scan request has gone through and that I should make another appointment at the imaging center at Shelby Baptist. They deny me an appointment, again based on insurance. So I call the insurance, ask what is Carelon and try to figure out what is happening.
BCBS has outsourced this BCBS plan to something called Carelon and they tell me that I can go to Shelby Medical Center, no problem. I call Shelby imaging again and tell them this. They still refuse to get me an appopintment so I call my doc again and have them try to work with the insurance co. They, and BTW, this is taking over a week to get this far, finally tell me that I can only use St. Vincent facilities in Alabama, not the facility that is right across the street. So, I make an appointment for the CT scan at St. Vincent, which is pretty far away. No big deal, I need to find out what is happening and I’m getting worried that whatever this is might really be a tumor that is growning.
10.03.2024: Meanwhile, I go to HeartSouth to do stress test and echocardiogram. As of October 18,2024 I have not heard a thing as to the results of these tests.
10.09.2024: I receive a letter that tells me that Dr. Segrest at Heart South will no longer be in network and that I need to find a new cardiologist by the new year.
10.10.2024: I got to St. Vincent to have CT scan of abdomen – which is the test that should be able to show the adrenal tumor, if present. As of October 18, 2024, I do not have any results.
More later…
