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Bill Roper's Journal
Yesterday 
29th-Sep-2018 05:59 pm
So yesterday was like this.

I crawled out of bed, feeling pretty rotten. Ate some breakfast that Gretchen brought back from McDonald's. Continued to feel rotten, so -- on the last day of my vacation -- crawled back into bed and took a nap for a few hours. Felt somewhat better, so decided to go out and get lunch.

Walked out to the garage and discovered that the folks who pick up our garbage had left all of the cardboard recycling that I had -- as requested by the folks at the main office for the garbage collection -- placed in a separate container, tossing the full container onto the ground so that the cardboard was falling out of it.

Called the number for the trash collectors and yelled at the person on the other end of the line who promised that they will send someone out to pick up the recycling on Monday. If this were the first time that I had had a problem with their recycling crew, I would not have been nearly so hostile. Sadly, they don't care. They don't have to.

As I was finishing lunch, I got a call from the sleep clinic where I am trying to get a sleep study so that we can check the pressure that I need to have for my CPAP, as the machine that I have is over ten years old and due for replacement and I haven't actually had a sleep study in over 20 years. United Healthcare rejected the request for an in-clinic sleep study, saying that I needed to have an in-home test first. The doctor at the clinic then called UHC for a peer-to-peer review of the request.

Three weeks after the peer-to-peer review, they finally sent through a final denial of the request for the in-clinic sleep study, so the clinic was calling to tell me that.

"Fine," I said. "Let's do the absolutely useless in-home study. Let's have them pay as much as they possibly can to deal with this." We make an appointment for an hour from now, I climb into the car, and head off towards Oak Park, calling Gretchen to let her know that I will not be home any time soon.

An hour and fifteen minutes later, I finally arrive at the office. (I have called them along the way to let them know that traffic is winning. No, traffic is not only winning, it is performing a touchdown dance in the end zone.) The nice technician takes me and the trainee into the back room to give me a briefing on the gear that I will be taking home for the in-home sleep study.

Here is the device that I will strap around my chest. Here is the clip I will put on my finger. Here is the tubing that I will insert in my nostrils so that the device on my chest can monitor my breathing. And that is everything.

"Wait a minute," I say. "I am supposed to sleep with this apparatus without my CPAP?"

"Yes, that's how it works."

"You realize that I cannot actually *sleep* without my CPAP? This will not actually work at all. I suppose that I can put it on for two hours and toss and turn, but then I will need to put on my CPAP mask so that I can sleep."

"Yes, we understand. And then the machine will show that the results are inconclusive. After three days of inconclusive results, they will give up and you can bring the machine back."

"So, basically, United Healthcare is insisting that I take a test that is going to try to kill me. Would you mind if I gave them a call?"

And off to the races we went, as I pulled out my cellphone, switched it into speaker mode, and dialed.

After speaking to *four* different United Healthcare representatives, in a conversation that was peppered with phrases such as "You are prescribing a test that is, in fact, going to attempt to kill me", "The doctor here and the doctor on the peer-to-peer consultation *agreed* that I need the in-clinic sleep study, but your person with the dartboard who is responsible for actually *approving* the sleep study has, for some unknown reason, rejected it", "You agree that I actually have *coverage* for the in-clinic study, but instead you are insisting on an absolutely useless test that is going to *try to kill me*", "I have spent an hour and fifteen minutes driving here through some of the worst traffic that you have ever seen, unless perhaps, you are in Boston, in order to find out that the test that you are insisting that I take to determine something that we already know (that I have sleep apnea, which, since I have been sleeping with a CPAP set to 16 pounds of pressure for 20 years, so this is in no way a marginal case of apnea) is, in fact, going to *try to kill me*"...

Well, you may start to detect a theme here. The tech and trainee were very amused to see the number of different ways that I could tear a strip off of someone without actually resorting to profanity.

And I was eventually routed to people that consumers are not allowed to talk to. These people only talk to *providers*. Happily, I was in the room at the provider *with* a provider and information was exchanged.

A call to the provider following an expedited review of this pre-authorization has been promised by 8:30 AM on Monday morning. Representative number four was gracious enough to be embarrassed about the fact that the pre-authorization had been previous denied twice.

We will find out next week whether they have inexplicably tried to go for the trifecta.

And then I got into the car to drive through rush hour traffic to the Windycon meeting.

About which I will say more later.
Comments 
30th-Sep-2018 05:57 am (UTC)
Dear gods.
30th-Sep-2018 10:18 am (UTC)
Matthew is on cpap # 4 or 5 now. With every one, his snoring is getting louder, interrupted sleep is getting worse and I have more and more trouble sleeping in the same room. I swear these insurance folks are brain dead.

IN my case, I am supposed to have an MRI every 6 months for the spinal degeneration to determine how fast the herniation is progressing, if its pressing into the spinal cord, and if any of the bulges have gotten worse. I was slated for surgery over 5 years ago. There are no alternatives to this. Pain management in this area is doc visits every 10 days (if you go to their website, its a shrink not a pain management doc) and the wait to get an appointment is over 3 months each time.

However I think I want you along next time I have to argue with these bozos. I am impressed you got through all that without profanity.
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