Wednesday, February 16, 2011

And . . .

Guess who I just noticed was on my News Feed? Ann Komis, that's who! For the out-of-towners Ann is a news anchor at our local NBC affiliate. Had she finally accepted my friend request? Why did I just notice her today? Today when a fire had been lit and was refusing to go out? Whatever. Enuff with the intro.

I decide to write her whilst I had my 'write-on.' And here's a little bit of how it went:

I titled it STORY IDEA.

Multiple Sclerosis, Alzheimers, Parkinsons may have found new hope. An Italy doc's wife got MS and he re-discovered an old vascular link. Thanks to the internet the idea is spreading like wildfire this time. I say this time because it can't be snuffed out by $$$ hungry drug companies. We are patients looking out for patients this time and not big societies looking out for a bottom line.

I AM SOOO MUCH BETTER. It'd be such a great story. Remember me? I took Broadcasting from you years ago at USI. And sadly I've had MS now for 10 years. But now I am getting better instead of worse. Google CCSVI for details. Before and after videos are all over youtube. And I'd be more than eager to show off some of my new skills on camera. Please, please, please consider this!!!

Sincerely, Angela Orth Spindler (USI class of '98)

And then of course I left all my numbers, blood type, first born child's information, etc. I'm comin' for ya Billboard!


So meandering thru the News Feed on Facebook as I do almost daily now, I stumbled upon an Asasociated Press link a friend had shared. Thank you Tessa! For those of you who don't know her Tessa is one of my first MS friends and hails from Canada. You simply wouldn't believe the number of Canadian friends I have these days. Point is, living waaay up there, she'd have had no idea whatsoever that this article would have peeked my interest so. Now sit back and allow me to share the articles title with ya.

Ind. Senate panel advances marijuana, meth bills

By The Associated Press

So as I'm sure she posted it for the as yet to be discovered, MS link but there are all too many of those floating around out there today and I pass many of them by without a glance. This one however grabbed me. Ind. --- well, I'm from Indiana. And meth??? Well, it just so happens the little southern town in Indiana that I live in, although its true name is Mount Vernon, has been called out as Meth Vernon from time to time. A quaint little rural community made up of mostly farmers, a couple factories and an oil refinery I'm sure our anhydrous ammonia supply makes us ripe for the meth manufacturing, but alas I digress and meth or no I love it here and wanna stay.

On with my story, or snip-its of the AP story first:

INDIANAPOLIS (AP) — A state Senate committee on Tuesday backed having the state crime policy panel study whether Indiana should legalize marijuana after hearing a legislator with multiple sclerosis say he wished he could legally try the drug to relieve his pain.

The committee also approved a bill requiring computerized tracking of cold medications used in making methamphetamine rather than mandating prescriptions, as some law enforcement groups urged.

Rep. Tom Knollman, who has multiple sclerosis and uses a walker, told committee members he regarded himself one of the most conservative members of the Legislature but that he believed legalizing marijuana for medical uses should be considered.

He said he has spent up to $25,000 a year on pain medication that often is ineffective. "I hear that one of God's plants is working to help ease the pain of multiple sclerosis," said Knollman, R-Liberty. "I know when my leg starts twitching and I hurt, I'm looking for any alternative."

Hmmmm . . . so I look this dude up. A Rep. since '08. A Republican. Previous employment? A farmer. Member in good standing of the National Rifle Association. Sounds like my kinda guy. So what if he reps Southeastern Indiana and not Southwestern. Close enuff. Plus the poor sucker's got MS. Hmmm, indeed. Lightbulb y'all. I get downright inspired. He has his own webpage. An easy email form. Kaa-chow! Five minutes later I'm clicking SEND. Here's what I said:

Blah, blah, bla with the form fillin' out. And then the point.

I realize I'm not in your district, however I just read the Associated Press article you were quoted in and discovered we have a little something in common. Multiple Sclerosis. I too am Republican and come from a farming family, etc. etc. I could go on, but I'm writing to be sure you have heard about CCSVI.

A simple venoplasty allowing proper drainage of blood from my brain back to my heart has made many of my 10+ years of MS symptoms disappear. Thanks to the internet a growing number of us are discovering neuros have too much $$$ to lose by admitting there just might be something to this.

Long story short my insurance company is refusing to pay on the grounds this is experimental. I argue that its discrimination. MS or not if veins are blocked causing blood back-up and havoc in the brain they should be allowed to be fixed. I hope you can help, but if not PLEASE look into this as it most likely will help you too. I've gone from a walker to using no assistance at all. Plus I've been able to stop two drugs totalling nearly $2,000 per mo. Kind regards, Angela Spindler

Sooooo, whatcha think? I only had so much space. My plan is to wait a bit for a response generic or heartfelt and then send an actual letter. To him and to every Rep in the state referencing him and his plea for help. Ahhhh, I love shit stirrin'. Ya know I may have missed my calling. I should be a politician y'all. What should I run for? Mayor?

But seriously, don't forget to officially become a follower if you would. Even tell your friends about me. Nobody has to really read me. I just need numbers to show Mr. Billboard. Like, "Hey, Buddy, this many people know how crappy you are treatin' me!" "Hey, Buddy. Can you spell fight?"

Anyways . . . Happy Hump Day y'all. Just needed to type a bit. Thanks for puttin' up with me. Love ya!

Wednesday, February 9, 2011

CANCELLED, you say?

Really? Cancelled? Terminated? Done? WHATEVER. Ahhhh, yeh. I'm fully aware thanks, but it was I that cancelled you Mr. Billboard. My family of four left you for greener pastures in 2011. Please, please let me explain. It was a tuff decision . . . NOT!

Ya see we left ya for an insurance company that covers "insert catheter in vein" as I believe you termed it. It goes by sooo many names these days. I prefer LIBERATION!!! But it can also be called a venogram. Venoplasty. It's very near kin to angioplasty. Ever heard of it? It too was experimental eons ago. But guess what? People got over it 'cause it saved lives.

Damn near what the procedure has gone and done for me. Given me quality of life back. Terminated my a$$. So once I clear up who kicked who's tookiss to the curb he continues, "Well it doesn't matter. What matters is that you are no longer a member and thus we do not have to allow you any further appeal." Oh yeh? Them was fightin' words. Jason left me the 300 today. Don't make me come over there!

Breathe in. And out. Makes me think of the radio skit, "How big a boy are ya?" Anyways I, as calmly as I could muster, explain that at the time of service I was still a member in good standing. Then of all things he tells me and I quote. Yes seriously. Pay close attention to this one. "You haven't had the procedure yet." WHAT? HUH? WHAT? REALLY? And this whole time I'd thought I was feeling better. Bunch of liars. Is there really even an Atlanta. Hello? Virginia? Is there really not a Santa Claus?

Only one word works here. And God forgive me please. But seriously?! Dumbass! So again with the phone silence as this new found bit of information has me baffled. No. A better word - bumfuzzleed. Anyways, I'd been knocked silent. And for anyone who truly knows me, that my friends, is hard to accomplish. Yet this Steve Billboard had gone and done it. I hope he didn't take it wrong but the next noise I could muster was a chuckle. And then a throat clearing to fight back the tears the pure upsurdity of the conversation had caused.

"I had my procedure successfully completed Dec. 10, 2010," I explained. And guess what? I think I baffled him this time 'round. Who in their right mind would pay out of pocket for an experimental procedure? Huh? Who indeed? More dead air. Then he explains I was not covered at that time. Then I explain I was. Then him. Then me. You get the jest. The long and the short of it was that I could go no further 'cause I was no longer a member.

Do not pass go. Do not collect $200. WHATEVER!!! I wasn't after $200. I was after $10,000. Grrrrrrr! So when we tired of the back and forth shenanigans I calmly asked, "What is it that you need from me next as I am no where near letting this go?!" And with that he suggested I start with having the facility that did the procedure send them a bill. NO PROBLEM! I would have thought they'd have done this already but perhaps because I arrived with $$$ in hand they hadn't seen the need. Or maybe they had and he was full of shit. Either way, I could call Atlanta. 'Cause yes Virginia they do exist! No biggie.

So I answer, quite simply, "No problem." And then he threatens that we'll have to start this whole denial and appeal process over again. Woooooo! So what? It's big money we're talking about here. If I don't get it out of them I'll still be paying on it in 5 years. You betcha I'm gonna fight for it. My cars gettin' old and about to hit 100,000 miles. The house needs a roof. The windows leak air. New carpet'd be nice. Remember, I can feel it now? I could go on and on here, but the point is --- INSURANCE SHOULD PAY!

So I thank him. Yeh, I know right? Overkill maybe. But Momma taught me manners. (FYI she also taught me to fight HARD and never give up. NEVER! Not even with your dying breath! Know why? 'Cause if your breathin' you ain't dyin' - just sayin' . . .) Again, I digress. So I thank him. And then I take a break to relax my jaw. HUH? Yeh, you read me right. Relax my jaw. Having realized I'd been gritting my teeth for much too long at that point I needed a Coke and some Advil. Darned headache. I needed a nap.

And I tried but needed to get this all off my chest. And awwww, doesn't that feel better? No? Well it does for me. Blogging (aka, bitching) can be very therapeutic. Wonder if the insurance was billed for blogging therapy if they'd cover it? Experimental? No, wait - I've been cancelled. Dah, dah, daaaah! Cue dramatic/sarcastic music.

Next then? Next I call Atlanta and write a letter requesting my appeal, THIS APPEAL, be brought to the next level. We spent plenty of our own money the first trip. Why shouldn't I fight for that too? Oh yeh. And be expectin' another appeal on the procedure. You know, the one I'm almost sure I had. And while your at it go on and bump it up to super dooper appeal status 'CAUSE I AIN'T CHANGIN' MY MIND!!!


My appeal rejection letter states the following: "Upon review of available information, WHP has determined that the above-mentioned services are experimental/investigational and not a covered benefit. Therefore, the charges for the above-mentioned services will remain your financial responsibility."

Blah, bla, bla. [grits teeth] Blah, bla, bla. It goes on to say: "If you disagree with this decision, you may request an additional level of voluntary appeal before the WHP Grievance Committee. You must notify WHP, orally or in writing, of your request for this additional voluntary internal level of appeal, within 180 days from the date you are notified of the first appeal decision."

Allllrighty then! Let's break this down, shall we? My supposed date of procedure was Nov. 18, 2010. And thus like a good girl should I attempted pre-authorization as is recommended to do. And guess what? DENIED. When exactly? Well I'm glad you asked. I was denied the very same day we were packed up and leaving for ATL. Anyways, old news.

So we go anyways. Surely there'd be a payment plan. Remember? Right? People don't just have $10,000 layin' around. $550 for the scan. $200 for the consult. And everyone else's insurances had paid - NO PROBLEM! Fine. We can appeal and reschedule. Or take out a very high interest rate 'medical loan.' Yikes! So if everyone else's insurances are doing it. Hmmmm. Maybe with a little hand holding, peer pressure, being shown the money they'd save . . . Just maybe they'd come around.

Y'all know the Welborn Health Plans billboard up on the Lloyd Expressway? Makes me literally sick to my stomach to see the smiling faces on there. Turn off the expressway then Angela before you wreck. Noooooo! There's one on 41 too. Bastards! It's a lie I tell ya. A lie! If they truly are the "BEST" . . . Lord please have mercy on us all. Ahhhh, but I digress.

So I launch an appeal. I even shared it with you. Remember? Took some re re re re-writing to get it to a 'G' rating but I got 'er done. No cursing even. Look it back up. I think you'd be proud. Anyways. Bottom line was savings. Costly monthly drugs vs. a one time procedure. Simple economics. Plus me feeling better = less medical expenses overall, etc. etc.

Screw it all. The hubs wasn't waitin' and the good docs appointment book was fillin' up fast. Before we left the office I was rescheduled for Dec. 10, 2010. That was to be my new birthday come Hell or high water. And we had both remember? Sure woulda been nice if I could have been LIBERATED in November. Just sayin' . . .

So you know the story. Nearly a month and $10,000 later (which we'll be paying on for 5 years by the way) I AM LIBERATED! Upon our return home we admittedly don't find opening the mail is a top priority for us however within a week to 2 weeks from our return we discover a letter from WHP. Yippee. A reversal of their initial denial perhaps? Hah! Laughable! Try a rejection of my appeal - this one dated Dec. 8, 2010.

And the wording. HILARIOUS! "If you disagree with this decision . . ." Now what pray tell could have happened that would have changed my mind in less than a month. Oh gees, if you say it's experimental Mr. big bad insurance company with smiling faces on billboards, then it must be experimental and scary so I MUST NOT WANT TO FEEL BETTER AFTER ALL! I mean really?!? If a couple of docs paid by Welborn Health Plans deem something experimental am I supposed to be okay with that?

Am I supposed to give up feeling better? Standing to brush my teeth? Washing my hair with my head tilted back? Baking? Walking? Staying up late? Getting up early? Feeling like going out? Playing with my boys? Thank God my husband could get a loan fast and easy. But what about the poor souls who have to listen to the billboard monsters? This sickens me. Seriously sickens me. Whilst I'm doubled over in angered despair riddle me this: Is this everyday procedure only experimental because I have MS???? Bastards!?!?! Forgive me.

Where was I. Ahhh yes. Today's oral requestfor "this additional voluntary internal level appeal" because NO, OF COURSE I HADN'T CHANGED MY MIND! So why had I waited so very long to notify WHP of my plans to go in front of this so-called Grievance Committee? Again, dear readers, I'm sooo glad you asked. I, as an Orth, a Spindler, an Angela, hahem (clears throat), I don't do anything half-assed. PERIOD. I wanted all my ducks in a row should they answer my request with a "come in to see us in an hour."

Preparation. I wanted all my clinical notes together. I wanted the disc of the procedure. I wanted before and after videos. I wanted a professional, well thought out plan of attack before proceeding. Up bright and early this morning. 2+9=11. Just a coincidence, but whatever. Today was gonna be the day. At least I'd be put down for wanting to take this to the next level which would catapult me into finishing all I would need to stand in front of this Grievance gang. As many times as I've typed 'grievance' in this entry I can't help but think of General Grievous. Just sayin' . . .

So at 9:25 a.m. this beautiful Wednesday morning I call. As per the letter ORALLY to me in these circumstances means I can call and or show up at their Evansville office and say: "I wanna take my appeal to the next level and go in front of your Grievance Committee." Or something calm and cool and curse word free like that. So I get a very nice CSR Sarah who gives me to Steve in Appeals. "This is Steve," he answers.

Whoopity doo. I thought. I gotta name too. It's even longer and more impressive than yours. Ha. Ha. Ha. Okay. I wasn't at all bitter at that point. Nervous maybe. Apprehensive sure. But I wasn't the pi$$ed off Angela you all know and love until much later on in the brief one sided conversation. Long story short - I'm well aware you have already denied me. And in both rejection letters it mentions different levels of the appeal process. Thus,

"All I'm wanting today kind sir is to notify you orally as per your last letter that I want to heighten this appeal to the next level which is to go in front of a Grievance Committee as I understand it sir." Welllll maybe I didn't use 'Sir' so much but I was civil and kind. My Momma raised me right. His Momma? I dunno. Anyways he says I cannot make such a request orally. Fine. His letter says I can, but WHATEVER.

I undestand trying to make it hard on someone. I mean ya can't just give $10,000 to anybody who just calls in and asks for it right? I was prepared to jump thru a few hoops. And you know what? Thanks to LIBERATION I even felt like jumping. Anyways. Anyways, back to the story. He tells me I must submit the request in writing. No problem. Whatever. His address right in front of me I verify it with him. 1. It's always good to do. And 2. I wanted to show him I had all my shit together so to speak.

An arrogant answer to follow I kindly retort "While I've got you could you tell me a little bit of what to expect going in front of this committee?" Blah, bla, bla. Doctor this. Specialist that. Vote this. All very formal, legal and scary sounding. I retort, "Should I bring legal council at this time then?" Whoa! Phone silence. Verizon guy, you there? Can you hear me now?

"No. No," he says. "This evening meeting is to be quite informal." Huh? We'll see about that. Again per the letter (that apparently doesn't mean beans): "You will have the opportunity to represent yourself or designate another person to represent you . . ." So ummm, yeh, I was a member of Drama Club in high school and I'm wondering if for show's sake I shouldn't rep myself and have about a dozen or so friends and family speak on my behalf as well. Any takers?

More to come my friends. After lunch I'll get to this billboard man actually calling me back. Actually telling me not to bother 'cause I'd been cancelled. What the #@*%???