a dash of ash

may 28 2024

I’ve always considered myself to have bad luck when it comes to seeking medical care. When I fractured both of my wrists (yes – both) in the second grade, it took three care providers to figure out that they were both in need of a cast. The first, a first responder that just so happened to see the accident, looked at them and advised to simply wrap them. A week later, it was clear I needed more attention. The first doctor I saw said that only one of them was broken, and my mom decided we needed a second opinion. The second opinion saw that they were both fractured. After getting hot pink casts put on both of my wrists at once, the doctor prematurely removed them, causing ongoing issues to this day.

While it can be considered unbecoming to discuss one’s medical struggles, I find it necessary for the sake of context (and I also look at writing all of this as a cathartic coping mechanism). For as long as I can remember, I’ve had abnormally long periods – bordering on two weeks most of the time. The first contraceptive pill I took in an attempt to combat this only made it worse, so I switched to a lower hormonal dosage pill at the advice of my primary care physician’s office in Michigan. This worked well for a while, until it didn’t. My senior year in college (early 2022), I began having two week periods, every two weeks. This was both emotionally and physically exhausting. I dealt with it much longer than I should have, because I am so hesitant to see a doctor when something is wrong (you will soon see why). I had eventually had enough; need I remind you that feminine care products are expensive? I was buying twice as much as someone with a “normal” cycle does – and on a college budget. I gave in and made an appointment with an OB/GYN in Fall of 2022. I spoke with the doctor about the horrendous, never-ending cycle my body was putting me through. He looked at the birth control I was on, and made the observation that the hormone dosage was low, and advised that I go on a different pill with a higher dosage of hormones without conducting any further testing. Desperate to achieve some regularity, I obliged. He instructed me to take it for 3 months, alluding to the fact that it wouldn’t take full effect until this time frame was reached. I made a follow-up appointment three months later, for January.

By the time January rolled around, I felt as though I had completely lost three months of my life. I fell into a deep depressive state, floating through my life day by day. I mentioned this to the doctor, and his response was: “Really? That usually doesn’t happen.” Needless to say, I made the decision to forego any other “advice” he could have offered and requested to be put back on the prior pill. While I’d be miserable every two weeks for two weeks straight, at the very least, I’d be present in my own life. Strangely enough, my periods began to regulate a little more – while they were still longer than the average, I was only having one every 25-30 days. But, while my cycle was regulating, much of my system was doing the exact opposite – and slowly, without my realization for quite some time. It wasn’t until September of 2023 that I noticed a steep and sudden gain of ~40 pounds with no lifestyle changes, paired with mood swings, heightened anxiety, hot flashes, and the fact that I hadn’t slept through the night in months. I decided it was time to find a new doctor to discuss these ongoing symptoms with. I found an office nearby my home, and made an appointment. I chose to make an appointment with a generic, family physician with the idea that if needed, they could refer me to a specialist. I nervously drove down the street on September 28, 2023, arriving to the doctor’s office. The nurse had mentioned that the doctor I was scheduled to see had worked in an OB/GYN office before, and for a moment, my hopes were high.

Those hopes were quickly struck down after I described my symptoms to the doctor and was promptly shamed for my weight. As someone who has struggled with body dysmorphia and disordered eating for years, I felt far less than heard by this individual that was supposed to be prioritizing my wellbeing. The doctor mentioned that, based on the symptoms I was describing, it sounded like I may have PCOS (Polycystic Ovary Syndrome), but that he would need to run a hormone panel to confirm. While the woman took five vials of my blood, I asked about the cost of the tests and was told that everything was done in-house, so the front desk would be able to tell me. I was also given a referral for a Transvaginal Ultrasound (which is just as daunting as it sounds). Upon leaving, I stopped at the front desk to ask how much I would owe, and was told “You’re good to go!” And, that was that. Or so I thought.

Imagine the amount of shock I went through a month later when I received a bill from a lab company (that they outsourced the testing to – without my knowledge) totaling $2,645. As someone who had only been working a full-time job for about a year and half (while living in the beautiful, but ever-expensive South Florida), I was not sitting on that kind of money to pay up immediately, and my heart sunk. I began panicking, and as many young adults do when they find themselves experiencing these situations for the first time, I called my parents. I was reassured that because the deductible was met, I should only be paying 10% based on the plan I was covered under, and it was likely a billing mistake – it happens all the time. Once I gathered my bearings and the initial shock wore off, I took a closer look at the bill. And much to my surprise, the doctor had ordered more than the hormone panel he initially mentioned – there was a comprehensive blood panel, along with multiple allergy tests, and a test for Celiac disease. None of which were covered by my insurance.

Being as proactive as I am, I began conducting calls the very next day. I called my insurance and was told that the tests were not covered because the code used for them (often indicative of the reasoning behind the procedure), didn’t align with the procedures themselves. I then called the lab company and explained the situation; luckily they put my bill on hold without argument. I called the doctor’s office, requesting to speak with the doctor or at the very least leave him a message. I received a call back from the office about two weeks later requesting that I make a follow-up appointment to discuss my lab results before any coding was changed. This felt very transactional – they were holding a $2,500 bill over my head in exchange for seeing a provider that I already did not trust. I reluctantly agreed and made a follow-up appointment. I then frantically called a location that conducted ultrasounds and made an appointment with them – I was worried that the doctor would not properly discuss my lab results without the ultrasound results. I managed to get an ultrasound the day before my follow-up appointment was scheduled.

I was so anxious to go to the follow-up appointment – it felt like I was not heard at all during the first appointment, who was I to expect anything to change? My boyfriend graciously offered to accompany me to this appointment, and I accepted. I needed all the support I could get. The doctor reviewed my lab tests, mentioning that nothing was off about my blood test results, and the allergy tests didn’t reflect anything. When I asked him why these tests were conducted, he reasoned that they were done to eliminate any other causes of the symptoms I was describing. When he discussed my hormones, he mentioned that my testosterone was high, and my estrogen and progesterone levels were post-menopausal. This, in conjunction with my ultrasound results, led him to diagnose me with PCOS, as he originally suspected. He also mentioned that there were different types of PCOS, and that I seemed to have Insulin Resistant PCOS. It was explained to me that, while my body produces an adequate amount of insulin, it doesn’t quite use it the way it’s supposed to; meaning that my body does not process carbs and sugar as it should. He went on to prescribe me Spironolactone (to combat the high testosterone, which I was fine with), along with Metformin. For those who are unfamiliar, I like to refer to this medication as “Ozempic’s sister.”

While Ozempic is all the talk in Hollywood right now, especially considering the effects of social media and influencers, it’s purpose as a medication is treat those that are prediabetic/diabetic and assist their body with utilizing the insulin their body produces the way that it’s supposed to. Was my being prescribed Metformin a hasty move? Not necessarily – it can be used to combat insulin resistance. But, did I agree with the way that the doctor described it as a “weight loss medication”? Absolutely not. I have not begun to take this medication, and don’t know that I will unless it is the only option – I have heard many horror stories of side effects, as well as what happens when you go on it and lose the weight, just to gain it all back once going off. I’ve been through enough misery that I don’t find it beneficial to risk more of it.

Before leaving, I mentioned to the doctor that my insurance had billed me an outrageous amount for the tests he had ordered, and that they had informed me that the coding was incorrect. He was adamant that the insurance was at fault, and advised me to consult with them and request they reprocess the claim. I asked why he required a follow-up visit to simply tell me that, and he denied that entirely. I left the office with two prescriptions (one of which would not be used), a recommendation to go on the keto diet, and to get more exercise – I was suggested that I swim “because [I’m] a Cancer, and that’s a water sign.” I also happened to leave that office with a larger sense of distrust and confusion surrounding the “care” I had received over the last two appointments with this provider.

For the next several months, I would continue to make calls to the insurance, the third party company billing, and the doctor’s office on my lunch breaks. I invested all of my energy trying to get to the bottom of this bill and get a resolved balance that reflected the coverage I was supposed to receive from my insurance. I was eventually connected to the Medical Supervisor of the clinic after calling enough times, and he requested I meet him in person at the office to go over the situation and provide a copy of the bill I received. He was very understanding and assured me that this is not the first time that a doctor refusing to recode their procedures has happened (which wasn’t as reassuring as he thought it would be). For the next few months, he assisted me to the best of his ability, submitting addendums to the original billing codes, contacting the lab to put the bill on hold yet again, and updating me on his progress. I received an updated bill from the lab for $2,495 – the insurance had graciously covered an extra $150! I let the Medical Supervisor know of this so-called improvement of the bill, and he informed me that following the submission of the updated coding, “the insurance left a note stating for the patient to call the insurance provider to further discuss. We have tried every option on our end unfortunately our addendums did not get approved.” I then called him, asking for further clarification on this comment, and during this phone call, he admitted to this situation being at the fault of the provider failing to code the procedures correctly.

At this point, I was approaching the six month deadline I was given all the way back in November when I first inquired with the insurance regarding the coverage of this bill. This deadline was for the very last resort option – submitting an appeal through the insurance. So, having no more time to call all involved parties, just to be sent in a circle over who was to blame, I compiled all of my documents – Member Appeal form, a supplemental letter, a list of document attachments, the itemized lab bill, a detailed visit summary with all my lab results, my email communication with the Medical Supervisor (and his written approval of my usage of this communication), along with the initial response to my inquiry providing the six month deadline that was rapidly approaching.

I received confirmation of the insurance’s receipt of my appeal on May 2, 2024 – with indication that a decision would be made within 60 days. 8 months later, and I still have no idea whether I will be expected to pay this outrageous bill. While attempting to resolve this issue, my physical symptoms have only worsened over those 8 months – I have debilitating nausea and migraines anywhere from 2-4 days straight before my period, and the hot flashes and inconsistent sleep persist. I’ve lost about 10 pounds, but not in a healthy manner. I mustered up the courage and made an appointment for myself with an OB/GYN nearby. I thought I’d be smart and make an appointment for a “Well Woman” visit (which is fully covered by insurance), and simply ask the doctor about my symptoms during the visit. This doctor did not have much more wisdom to provide than that which was already bestowed upon me. She had a much more casual outlook on PCOS – she informed me a diagnosis for PCOS is based on three symptoms, and if a patient meets two out of the three, they can be diagnosed with PCOS. She went on to note that four in five women meet this criteria, and PCOS is not something that should be stressed as something that I “have.” I provided her my lab results from the prior doctor, and she said the only thing that stood out to her were my estrogen levels, asking if I had a regular period. When I confirmed, she seemed shocked, and mentioned that my estrogen levels are so low that I should not even have a period. Despite her surprise, she didn’t seem concerned. When I asked for solutions, her only suggestion was to change my birth control. As covered in the beginning of this narrative, I have gone through enough with altering my birth control – that’s out of the question. She mentioned an alternative supplement – one that combats menopausal symptoms. I am 22. Upon leaving, I was charged $150 for that three-minute conversation that got me absolutely nowhere closer to a solution.

As I begin to lose all hope in finding a solution for the miserable symptoms I endure on a daily basis, I still check the mail awaiting a decision letter from my insurance regarding my 8-month old bill for lab tests that didn’t matter, and haven’t gotten me any closer to a solution. I checked the mail today only to find a new bill for $267 from the clinic I visited in December for a visit from 5 months ago.

It’s officially taken more doctors than it did to figure out I had two fractured wrists, and that’s saying a lot more than it should.

Edit: September 21 2024

When writing the above, I had no expectation that my journey would still be ongoing almost a calendar year after I first sought out treatment. I received communication from my insurance in the beginning of July, explaining that they required a 21 day extension of the original 60 day decision deadline, as they were investigation my appeal had been prolonged. I was provided the explanation that they were communicating with the local insurance, as well as the laboratory, and they would reach out with a final decision after the additional 21 days.

On July 18, I received a phone call from the insurance representative with the update on my appeal decision. I was informed that my insurance covered the laboratory tests conducted on September 28, 2023 to the extent that I only owed $44.14 on one claim, and $12.60 on the respective claims. It was explained to me that the addendums submitted by the Medical Supervisor were accepted by my insurance plan, but because my insurance was a Michigan-based plan, the local plan for Florida works as a middle man, and for whatever reason, did not communicate this acceptance with the laboratory billing department. They then explained that the local plan had confirmed the receipt of my Explanation of Benefits and would be providing this information to the laboratory, but because my claims were technically accepted, I would have to withdrawal my appeal. Near tears (with no exaggeration), I thanked them for investigating this issue and requested all of this information be communicated in writing to me as well.

I received the letter with all pertinent information not a week after this conversation, and it was such a weight off my shoulders to have evidence of my insurance confirming the coverage. My laboratory bill was still on hold, but I was certain this would be the end of what had turned into a time consuming and stressful battle.

Of course, this certainty didn’t manifest into actuality. I received an updated bill from the laboratory on September 6. As I opened the PDF, my heart sank as I read the balance of $2,304.36. However, this time was different because I had proof of coverage from my insurance. I called the laboratory immediately and explained the situation. I was informed that the adjustments in the coding allowed for additional insurance coverage of $191.57 that was not yet added to the bill. I then countered, letting the representative know that I had a letter from my insurance clearly stating that my owed balance should be a total of $56.74. I was placed on hold as the representative I spoke to tried to get ahold of the individual that was managing my case, to no avail. I was asked to send the letter to a general email inbox for review, and told that it would take roughly two weeks for them to process it.

On September 17, I still had yet to hear anything from the company and decided to take it upon myself to call and request an update. After briefly explaining the situation, and receiving the basic information regarding my bill as far as adjustments and payments made by the insurance, I noted that, if the insurance only covered roughly $300, and I am left to owe $2,300, that clearly something seems wrong. The representative then argued with me and told me my deductible must not have been met. I then countered, once again, with the fact that I had a letter from my insurance indicating that I should only owe a total of $56.74 and that I was asked to send it and still had not received confirmation of the receipt of this letter. I was told the communication team would get to it, but if it was just a letter, I would need to secure an Explanation of Benefits from my insurance and provide it to the lab company for anything to be changed. I inquired: “I have to send it?” and was met with a confirmation, and a claim that the insurance would not send it to them. After noting that, as the aforementioned letter stated, the local plan provided the laboratory with an Explanation of Benefits in July, the representative’s demeanor changed. I very dryly requested that they tell me exactly what they need from me, if that letter does not suffice, to process my insurance coverage and update the bill; mentioning that, as someone with diagnosed generalized anxiety disorder, the debacle of this bill has severely depleted my mental health and trust of medical providers over the last calendar year. While I didn’t think victimizing myself would necessarily work, he then put me on hold to look into my file. I was taken off hold, and informed that the balance I owed was $56.74.

As fate would have it, when all of this began almost a year ago, I was told by each party that it was another’s fault: the provider told me that my insurance was at fault, my insurance told me that the laboratory was blame, and the laboratory told me my provider was the root of the issue. In the end, each party was to blame for some instance of lack of coverage of this bill – initially, the doctor, then the insurance, and eventually, the laboratory.

After almost a full calendar year, I’m hoping that this phone call is the last step taken, but have unfortunately learned not to hold my breath. However, the day I receive the corrected bill, it’ll get framed and hung right next to my Master’s Degree, which took less time to earn.