It is with a sad heart I report the status of the healthcare system in America as broken and with no hope in sight. When the Affordable Care Act was passed into law (and survived numerous attempts to repeal or severely limit it), I was excited. Finally! Everyone now has the opportunity to have healthcare coverage. We are finally moving towards universal healthcare like EVERY OTHER DEVELOPED COUNTRY IN THE WORLD!!!
But I was wrong! I had been misled. It is possible to have health insurance and still not be able to afford to go to the doctor and/or afford testing ordered by your doctor. Sad, but true… With copays to see specialists usually set at $50 per visit, who can afford to go? And when a test is ordered, no one can give a definitive price for it. I know one woman who thought she was being smart by shopping around for a cheaper MRI. She went to a specific facility because they quoted her the best price under her insurance. Guess what? The final price billed to her insurance company and then to her was significantly higher that what she was quoted. Upon questioning the facility, they said there were other charges applicable on top of the simple price for an MRI. Of course, they failed to mention those extras when she was shopping around. There is no system of accountability when this happens. No other business in this country could get away with blatantly irresponsible behavior. There is no governing body responsible for ensuring that patients and health insurance companies are not being bilked by providers. There are serious consequences to this lack of oversight.
I briefly knew a woman I met through my advocacy efforts. We talked during monthly conference calls and on Facebook. This past May, I got the opportunity to meet her in person at the Caterpillar Walk in New York City to raise awareness and funds for fibromyalgia. For a few short months, this free-spirited woman suffered from debilitating nausea, vomiting, and other gastrointestinal problems (on top of her fibromyalgia and other chronic health issues). Because of the ACA, she was able to afford health insurance and was finally diagnosed with clostridium difficile colitis. WebMD defines this as:
bacteria that can cause swelling and irritation of the large intestine, or colon. This inflammation, known as colitis, can cause diarrhea, fever, and abdominal cramps.
It is a completely treatable illness. There is no morally acceptable reason for an insurance company to deny treatment coverage – but hers did. She could not afford the inpatient treatment that her doctors recommended without insurance. So she did the only logical thing she could think of – she switched insurance companies. Less than a week after switching health insurance companies and finally being admitted to the hospital for treatment, she died. Allow me to let that sink in… She died from a curable illness. She died in a country that prides itself on being THE BEST in everything (even when it is not). She died where help was only a breath away. She died…
Unfortunately, this story is not unique. It happens all too often.
May 12th is Fibromyalgia Awareness Day! This year I plan to attend a walk in New York City to raise money and awareness of this disabling disorder. It is called the Caterpillar Walk and will be held this Saturday. My wonderful son will be accompanying me. I think he is most excited to be going into the the city. He has never been even though we have driven by or stopped on the outskirts numerous times. I am also excited (er… nervous) – (1) I have never driven in NYC before, (2) with my brain fog, I am worried I will get hopelessly lost, (3) I will forget where I parked, (4) what if my feet and legs are in too much pain? (5) what if I am too fatigued to drive home? The worries are endless…
Raising awareness for any illness is important. It helps when we are advocating to legislatures about allocating funds for research and treatment options. It helps when we are raising money for advocacy and research. It helps when trying to explain our symptoms to family and friends, and even strangers.
So, for those of you who are not familiar with fibromyalgia, here is the 30-second elevator speech version:
Fibromyalgia is a chronic pain disorder with a variety of symptoms, the main ones being: fatigue, sleep problems (including insomnia, sleep apnea, non-restorative sleep), cognitive dysfunction (also know as brain fog or fibro fog), stiffness, tenderness. Other symptoms that can occur are depression (because who wouldn’t be depressed sitting around all day in pain?), anxiety, migraines, acid reflux, irritable bowel syndrome, irritable bladder, pelvic pain, temporomandibular joint disorder. Doctors do not know what causes this condition but research has shown it effects the central nervous system, immune system, and the sympathetic/autonomic nervous systems.
In a nutshell, it sucks. As a Guns & Roses songs states, “What we have here is a failure to communicate.” It is like our bodies are out of sync and rebelling against us. This has a profound impact on our daily quality of life.
I have a challenge for all of you who do not have fibromyalgia. Place a clothespin on one of your fingers. Can you last ten minutes with it on? How about an hour? A day? That is only one of the symptoms people with fibromyalgia live with on a constant basis – only we never get to take the clothespin off.
When I got pregnant with my one and only child, I was an active and vibrant twenty-something year old. I had a great career that allowed me to travel all over the country. It challenged me at a level I wanted and, not to mention, it paid awesome. Those early years of parenting were difficult as a working parent but so worth it. I have to admit I felt like Supermom. Mom by night and worker bee by day. I thought I had it all. At some point, I switched careers so I wouldn’t travel anymore and could be home every night with my little one. But I still felt like Supermom. I am sure other working parents can relate.
Then IT happened…
I was about to turn 30. My husband and I were talking about having another child. I was comfortable in my new job. I was happy. But then I got a headache. I was never one prone to getting headaches – maybe one or two per year. But this headache was different. It didn’t go away for two weeks. And then it came back for a few more weeks. I knew something was wrong. I knew this was not normal. It took me several appointments with my family doctor and a neurologist who didn’t specialize in headaches or migraines before I realized they couldn’t help me. However, I am a researcher and did my due diligence. I found a top headache/migraine center not too far away in Philadelphia called the Jefferson Headache Center. It took two excruciating years of trial and error – plus a week-long stay in the hospital – to stop my now daily, chronic migraine. I felt like I was in a nightmare until the pain stopped. However, by then, my brain and central nervous system had been rewired to amplify any and all pain while decreasing the neurotransmitters that suppress pain. It was a formula for fibromyalgia that was eventually diagnosed a year later.
Meanwhile, I was still trying to be Supermom to my little toddler. He was only three-years-old and could not fathom what was going on. I put all my energy into hiding my illness from him while my husband and I frantically looked for answers for my health. For those few hours after work that I would spend with my son, I would try to be active and play with him only to crash as soon as he was in bed. It was a strain on all of us.
Despite my best attempts, my son knew something was wrong. The pain was written all over my face. It was programmed into the way I walked, the way I moved. I could not hide it from those close to me. One night I was crashed on the sofa while my son played with his blocks. He came over to me with his Jaffy (an orange, stuffed giraffe he got as an infant and could never be without until he was ten) and place the raggedy animal on my head. “Jaffey will make you feel better, Mommy,” he said. It was so cute and sweet that I wanted to cry. My illness was already impacted my son. I felt like a failure as a parent because I couldn’t protect him from seeing his mom hurting. It was my first lesson in parenting with a chronic illness.
I am in the middle of appealing Medicare’s decision to NOT pay for my annual wellness visit with my primary care physician. When I called my doctor’s office to find out if they had any idea what the problem was, I was told that there are numerous billing codes that can be used for an annual wellness visit, BUT Medicare only covers a pitiful few of them. What the heck is going on? Doesn’t Medicare realize that I am on disability due to several chronic illnesses (although none of them keep me from complaining online) and need periodic checkups to monitor my health? I take numerous medications that can negatively impact my liver and/or kidneys at any time. Without annual testing, a problem can go unnoticed until it is severe – or deadly. Doctors rely on blood and urine testing to make sure medications are not destroying their patients.
During the same wellness visit, I also complained about problems swallowing and severe heartburn – the type of heartburn that keeps a person from eating just to avoid the pain. I think THAT qualifies for a visit to the doctor. Don’t you? I saw my primary first to find out if I should see a specialist and to get recommendations. Isn’t that what my doctor is there for? If Medicare won’t pay for a visit to the doctor when I am sick, what will they pay for? Incidentally, they had no qualms about paying for my specialist bills. So what gives?
As I said in the beginning, I am in the process of appealing. My first appeal was denied so I am appealing the appeal now. I came to find out that Medicare requested my medical files from that visit for review a few weeks before the holidays, which was ignored by my doctor’s office because the person who sends the files is out until the middle of January. Seriously? No one in the doctor’s office could make simple photocopies and fax/mail them to Medicare? Apparently my doctor’s office doesn’t want to be paid – I keep ignoring their bills in the hope that Medicare will eventually come to their senses and pay for my $224 doctor’s bill. Come on, folks! I am on disability. Do I look like I am swimming in $100 bills? Anyone who collects Social Security (for retirement or disability) knows that every year our benefits cover less and less as inflation raises the prices around us. It is like being frozen at the salary you last made even if that was 10 or 20 or more years ago. Not the best of situations, I tell you.
So, Medicare, when are you going to get off your stingy butt and eliminate all this red tape regarding paying for annual wellness visits?
When I graduated from college, so long ago I can’t remember, I was all set to be an adult and build my career. I was lucky to get a dream job at a management consulting company. It was ideally suited for me. I was given projects to work on independently in my little office. I got to travel all over the country and even back to my home country of Canada. I spent some of the best years of my life there. I was making good money and having fun. Of course, this was all before chronic migraines and fibromyalgia and arthritis…
I was the breadwinner in the family. I earned more than my husband and we were okay with that. I had no intention of ever giving up working. I just couldn’t see myself staying home with the kids while my husband supported us. That simply wasn’t me. I was going to be one of those Super Moms who had a career and kids. I could handle it; I was good at multitasking. I had the world’s best daycare center taking care of my son. I knew he was in good hands so I focus on my work.
Then I was laid off and found a new job. It wasn’t exactly what I wanted to do but that didn’t keep me from trying to excel because that is just the way I am. Even with a crappy job, I wanted to do the best job I could. But then I got sick. I started missing work. I used the FMLA to get a reduced work schedule because my migraines were so disabling. However, I remained the breadwinner up until I had to quit because of my health. I could no longer manage to work. It was a devastating blow to my ego. Being part of the rat race was a huge chunk of my identity. Without it, I felt lost. Being a mom is great but I wanted, and still want, so much more. I spent so much money and time on getting an education. I didn’t do it so I could stay home babying my fragile health. I was proud of being able to take care of my family financially. Being out on disability was not my dream – let me tell you it sucks.
To combat my identity crises, I started working with nonprofit groups. I took over the local support group for fibromyalgia and chronic fatigue syndrome. I joined Leaders Against Pain (a part of the National Fibromyalgia & Chronic Pain Association). I am becoming an advocate for those too sick to do it on their own. I am giving back to the community in a positive way. But I still miss working. I still miss the joy everyone has on Pay Day. I am still young enough to have hope of jumping back in.
The most disturbing part of having a chronic illness is find a doctor to oversee my treatments. Having more than one chronic illness simply increases that search exponentially. If you have bipolar, your get sent to a psychiatrist. However, psychiatrists are trained by pharmaceutical reps (and let’s face it – Big Pharm is the real driver of healthcare these days) to throw medications at their patients. They don’t have time for “talk therapy” or cognitive-behavioral therapy. They no longer seem to connect with those professionals who do. Don’t bother asking for a recommendation to a good therapist. The disconnect is an ever-widening chasm that few patients have the stamina to bridge. We are left to randomly calling therapists out of a phone book or, more likely, from the list our insurance companies offer up. We all know how well that works out, right?
If you complain to your family doc about migraines, they send you to a neurologist. But did you know that migraines comprise a small fraction of what most neurologist know? Most docs don’t even know that there are headache clinics out there that only deal with migraines and headaches. What a shock! How is a family doc supposed to manage our care if they don’t even know what specialties exist in the world of medicine? What are they actually learning in medical schools these days?
Now if you are lucky enough to have fibromyalgia (I know you can’t actually hear the sarcasm behind the word “lucky” in print), the knee-jerk response from most family docs is to send you to a rheumatologist. But wait! Did anyone ever ask the rheumatologists out there if they want to treat fibromyalgia? They only got stuck with it based on an outdated, obsolete definition of an illness that research has redefined into central nervous system disorder. WTF!!!
The bottom line is that family docs are poorly trained to refer patients with chronic illnesses. They pass their patients on to others hoping they don’t come back. Specialists, like most docs, are trained to run tests until something comes back positive for a disease. Then they cut something out or medicate the problem away. They want to cure their patients, not have a long-term relationship with them. And who can blame them? Modern medicine works best for those illnesses that can be cured. It is ever so disheartening to see the same patient over and over again without making their problem go away.
Chronic illnesses are the ugly step-child of the medical community. They require a lot of patience from both doctors and patients (no pun intended). Most illnesses that fall into this category are treated like that Whack-a-Mole game we all played as kids. Every time a new symptom pops its ugly head, the doc whacks it away with medications, physical therapy, or even some Eastern approaches that have slowly crept into our Western medicine. Is it any surprise that the patients keep coming back?
In the perfect world, there would be a cure for every illness. But since that utopia is out of reach, the medical profession should be more open to managing our chronic illnesses.