Posted by: jeanne | August 13, 2010

follow up, my cardiologist

i was supposed to go in for an mra this afternoon.  that’s an mri-angiogram, a picture of the heart in sort of action.  they were going to measure the size of my ascending aorta.  it’s hard to do this with a regular outside-of-the-chest sonogram, because of the ribs and such, so they either stick a sonogram probe down your throat to get past the ribs, or they bombard you with radiation and can see everything.

but the last time i tried to get an mra, two years after the last one, my insurance said forget about it.  so we tried to do a transesophageal echocardiogram, and it didn’t work.  twice.  once because the machine didn’t work and nobody’d bothered to test it, and the second time because no matter how much fentanyl and versed they pumped into me, i choked like i was going to rip my esophagus right out.  so really, the only option is the mra.

i suspect the insurance balks because there’s nothing wrong with me.  all the cardiologists who’ve seen me say i’m completely normal, just a bit on the large side of normal, nothing to be concerned about.

and this is because they aren’t familiar with the particular brand of aortic aneurysm i and all my family have.  according to my sister, a pioneering patient in this study, my family are unique in their presentation of this syndrome, and she’s already been written up in the journals.  they’re very interested in my family, as every one of us has the same enlargement of the aorta that killed my father.  and since this particular brand of heart trouble runs in families, they’re anxious to study us all.

which helps nothing when the insurance company says no.  the trouble is that my doctors here in atlanta don’t know anything about the familial syndrome, and so pass off what would ring alarms bells if they knew, as ‘completely normal’.  so my certification fails to mention that i’m in any particular urgency, because the doctors think i’m just fine, and so the insurance doesn’t see anything pressing, and deny it to save some money.

if i could get to a few major cities in the northeast, then i could pay out of pocket to see the doctors who know something about this.  it would be worthwhile if just to get a clear picture of what’s going on in my body.  but alas there aren’t funds for that until a certain tenant pays the back rent.

so at this point my irish sister is trying to see if her doctor can see me, because he knows about it.  but there are probably hurdles there, too, and probably a financial hit i’m not prepared to take.

i was all signed up to do an mra this afternoon, and something about the entire proceeding (prior bad doctor experience) had me on edge, so i called to find out if the insurance had actually said okay on this procedure, because the last time anybody asked, they had said no.  it took all day for the girl in precert called me back to say she wasn’t able to find out anything, and she said she’d call me this morning.

but she didn’t, and so about an hour before i was supposed to be there i called her, and she told me that insurance approval was still pending, but that i should come in and sign the waiver anyway, because they often approved it after the procedure was done.

but i’m not that much of a fool.  if i signed the waiver, and the insurance company declined coverage, then i would be responsible for the test.  and i’m sure an mra is very expensive, a thousand or more.  and i’m not at all sure the insurance is going to okay it.

i think the cardiologist went ahead and ordered an mra because i went in there expecting something.  he didn’t listen when i told him what the insurance would say, and he didn’t think there was anything wrong with me to begin with, so he ordered it because that was the least he could do, and it would teach me right if i ended up having to pay for it.

this is a guy who works in a teaching hospital.  he’s a few years older than me, he’s spent his entire career in this teaching hospital, he’s used to residents looking up to him as if he were god.  he pronounced, threw a few words around, and swept out leaving them stunned behind him.

anyway, i’ll follow up with the insurance on monday, and we’ll see what we have to do to get my ascending aorta measured.  in the meantime, i’m going on as if i was as okay as they assure me i am, slinging 50 pound suitcases around as if they were 35 pound toddlers.

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