A fall goeth before my pride

This week started with a fall. I was carrying some things into my shed last weekend. On the third and final trip, I slipped on the ramp coming out of the shed and fell hard on my butt. It’s my own fault because the ramp, being on the north side of the shed, had some moss/algae (green stuff) on it that I should have attended to before. Being wet and slimy, the ramp was an accident waiting to happen, as the say. Well, the accident happened. Lynn reminds me that it’s important to note that what I incurred was a slip-and-fall and not just a fall. Whenever I go to the doctor’s, they ask me if I’ve had any falls. I guess they want to know if my coordination is going. Next time I go, I’ll have to explain that I had a slip-and-fall and not a regular fall. I don’t know if they’ll buy that. They’ll probably just put a note in my chart stating “patient reports experiencing a fall.”

After I slipped and fell. I lay there for a moment evaluating my condition. My left knee was badly twisted because my left leg stayed planted while my right leg slid out from under me. I still have a nasty bruise on that knee although it doesn’t hurt very much now. My butt, hip and back hurt like hell. I wasn’t sure if I would be able to get up and I looked around to see if anyone could see me. I was visible from the road but only if someone passing by looked down my driveway. I was glad of that even though I was home alone and, as I said, not sure if I could get up. There’s that pride thing, which is stupid because if I couldn’t get up, I would have had to crawl to my car to get my cell phone to call for help. The good news is that I was able to get up and I wasn’t hurt as badly as I thought. My lower back hurt like hell and still does, especially in the morning. It’s getting a little better each day, but just a little. The healing for these things is slow, or so I’m told. I’ve never had a back injury like this before and I hope to never have another one. Two Excedrin Extra Strength in the morning seem to take the edge off enough so that I can function during the day, but I still can’t do simple things like bend over to pick up either of our small dogs.

I remember when I was lying at the bottom of the ramp thinking “Really? Melanoma, diabetes, colitis aren’t enough, you gotta throw this at me, too?” OK, so it’s not the trials of Job, but I admit to feeling a bit sorry for myself this week. And then came my battles with the insurance company. Poor Job never had to deal with Cigna.

Let me explain. On the Monday after my fall, it was time to replace the sensor for my CGM (continuous glucose monitor). This is something that I have done about a dozen times before as they need to be replaced every ten days. I’ve never before made an error causing we to waste a sensor but this time I did. It’s embarrassing for me to report what I did but it is just stupid, stupid, stupid. Honestly, it stuff like this that makes me seriously wonder if my cognitive skills are declining. Each sensor comes with an applicator and each applicator has paper on the the outside that you need to remove before applying the sensor. The paper has a code on it that you need to enter into the app in order to activate the sensor. Well, I forgot to remove the paper before I applied the sensor. I remember thinking that it didn’t look right and as soon as I realized why it didn’t look right, I knew that I had screwed the pooch. I had wasted my sensor because you only get one shot at applying the sensor. If you have to take take it off, or if it falls off, you can’t replace it. I had wasted that sensor and I didn’t have another one to replace it, so I would have to reorder another box from the pharmacy and wait until the next day to replace it. Or so I thought.

This is where my new nemesis, Cigna, comes in. Of course, they denied the claim. This wasn’t totally unexpected as this was the first time I had requested CGM supplies through them. BCBS had also denied my claim for CGM supplies, but the appeals process was pretty straight-forward and in short order they did approve them. Not so with Cigna. I’ve spent literally hours on the phone this week talking to the various insurance contacts, my endocrinologists office, and even CGM manufacturer (Dexcom). I’ve honestly lost track of who I spoke to when, but I can say that the staff at my doctor’s office was not very helpful, nor was my doctor responsive when I placed multiple calls trying to get updates from them. By Thursday, I thought I had found the correct paperwork that they needed to fill out (or so I was told by one of Cigna’s customer service people), and because the staff at the doctor’s office kept claiming that they weren’t getting them on their fax machine, I printed it out at home and drove the thirty minutes to the office to hand-deliver it, only to be informed by an irritated medical assistant that this was not the correct form. I’m not sure that it wasn’t the correct form, but who was I to argue? I was also informed by her that it didn’t do any good to call every hour as that just slowed down their work and made it more difficult to deal with my request as they had other patients to deal with, blah, blah, blah. I told her that I would not have had to call so often if someone had just returned one of my phone calls so that would I have had some inkling that my request hadn’t fallen into a black hole. So, from the waiting room, I called Cigna again. Then, whomever I spoke to on the phone told me that, lo and behold, my request was marked for approval but that the doctor needed to submit the prescription to their pharmacy benefit provider along with the appropriate paper work. Apparently, this is because CGM supplies come under the heading of durable medical equipment (DME). To me, something that only last ten days doesn’t seem very durable, but again, who am I to argue? I left a note for the M.A. giving her the correct contact information. Next day, Friday, I follow up with the doctor’s office and the pharmacy benefit provider and find out that the doctor had submitted the prescription but that there’s more paperwork that they need to provide. I’ll have to follow up on Monday to see where that stands.

The good news is that on Friday afternoon, I did get a call from a nurse at the doctor’s office who informs me that the doctor is sorry for the delays and confusion (yeah, me too!) and that if I can come into the office they have a sensor that someone has donated that I can have. I drove to the office (again) and picked up the sensor, but I still haven’t put it on. Why? Cigna.

One of the main reasons I was so stressed about getting my sensors is that I have a PET scan scheduled for May 6th. In order for me to have the test, I’m not allowed to take insulin or have anything other than water six hours prior to arriving at the hospital. I’m also not allowed to have a blood glucose level higher than 220. If it goes above that, the scan will need to be rescheduled. Achieving this control is going to be tricky and I cannot imagine doing it without the CGM. Therefore, I have one sensor at this point, and I don’t want to waste it. At this point, Cigna has not approved me for more CGM equipment and they have also not approved me for the PET scan. I know that insurance companies don’t like to approve PET scans because they cost a lot more than CT scans but the PET scan is really the only way to see if the shadows on the CT scans are active tumors. I think that there’s a good chance that Cigna will eventually approve it if my doctor can make a good argument for it, but there’s also a chance that the scan could be delayed, in which case it could get pushed back beyond my one sensor’s ten-day expiration date. So I’m hoarding that sensor until I’m sure that either I am approved for more CGM equipment or my PET scan is approved and on schedule.

All of this is just adding to my stress level. Every time I get scan, I’m nervous beforehand. Patients refer to this as scanxiety. It’s common and expected because each scan reveals whether the cancer is progressing (getting worse) or responding to treatment. In the past, I was nervous, but I always felt that if it was progressing we could give the treatment more time or try a different treatment. Well, now I’m off treatment and I don’t really have a plan B because my various immune-related side effects would make me ineligible for most other treatments, even trials. The nivolumab was really my last best shot. So, yeah I’m very, very, nervous and that’s not helping my mental state or emotional state.

Wish me luck.

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