Two men walk into a bar. One says to the other, I am having a colonoscopy Friday. The other says, the colonoscopy isn’t bad, it’s the nasty drink beforehand that makes me want to puke. The first man says, Be a man. Suck it up. Use a straw to get around the nasty tasting concoction. And so, I will use a straw and suck it up!
One week til my colonoscopy (a Tuesday) – Urban legend is correct; the worst part of the colonoscopy is the foul liquid drink that makes my intestines as clean as a whistle. It’s so nasty that in the past I have wanted to barf. Five years ago, I took the contemptible brew with lemon Gatorade and now I hate Gatorade.
As a veteran of the colonoscopy, in seven days I will be having my fifth one. Usually colonoscopies are every ten years, but since my dad, my brother, sister and I have all had polyps, I am on the five year plan. Despite the invasiveness of the doc’s scope up my rectum, I don’t miss a date with my gastroenterologist. It’s hard to argue since colonoscopies make colon cancer one of the most preventable cancers known to man and woman.
First, to minimize the noxious taste of the liquid laxative, I have learned from our recent month in California that a straw can bypass some of the taste buds in my tongue. Certainly, sounds promising. I’ll report back in seven days.
The colonoscopy itself has never been an issue as I am sedated and wake with no recollection of the sinuous scope with a camera and snippers that has snaked its way through my large intestine.
Five days before (Thursday) –Arriving home after indoor pickleball, I have a call from Atlantic Digestive Specialists (ADS), whose Dr. Hyett is going to do my colonoscopy next Tuesday. It seems that Houston, I have a problem.
Though seven weeks after I set up an appointment for my colonoscopy, ADS informs me that they do not accept my Aetna Medicare Advantage health insurance. What! You are telling me this with five days before my procedure!
Calling my Aetna customer service rep, I find that they disagree with ADS and say all nine gastroenterologists of ADS accept my insurance. ADS begs to differ, and they say, in so many words, you are shit out of luck (a little colonoscopy humor). I’ll set the scene more visually for you. ADS is the creek. I am up it. As you might have guessed, I have no paddle.
There is no arbitration, no appeal, unless I want to pay the $896 doctor’s fee that may increase if there are polyps or other complications. I have no choice but to go to Plan B – I get on the horn and call Aetna to find what local gastroenterologists will accept my Medicare insurance. Fortunately, there is a Dr. Thompson in Kennebunk (24 miles away from York) of the Southern Maine Health Care Gastroenterology (SMHCG) practice who is in-network and accepts my insurance.
SMHCG does have appointments, but they need one little thing – my colonoscopy files from ADS. Assuming the files will arrive within the month, Donna at SMHCG tentatively schedules me for June 6 at 9A, four bleeping weeks away. Are you shitting me? (I couldn’t resist.) Supportively she adds, we do have earlier appointments, even one next week, but we need the files of your previous colon exams faxed to us.
Calling ADS with urgency in my voice, I learn it’s not all that simple. I first have to sign a release. Kelly at ADS says, I can mail you the release. But in my mind, I know that could take the better part of a week for me to receive it and mail it back. I have no choice but…
…to jump into my Prius and drive to Somersworth, NH (25 miles from home) where the ADS files are kept. Without thinking twice, I tell Kelly I am on my way to sign the release. See you within the hour. With Hannah shaking her head in disbelief that I want to drive to Somersworth for the files, I am out the door in five minutes for the 30-minute drive.
Once there, I approach the receptionist who explains that any request for files can take up to 30 days. I explain my sad story and she says you can make an urgent request that may help it be faxed in five days. I do, and she promises to walk my request to Kelly’s office immediately. True to her word, she does, as I head out the front door of ADS knowing that I’ve done all I can.
Never thought I’d be so looking forward to the colonoscopy prep with its foul tasting laxative and the procedure itself now that I no longer have a Tuesday appointment.
Sometimes you win, and sometimes you learn.
Let’s summarize. I have learned with a Medicare Advantage health insurance that it is my responsibility to see if an elective procedure is covered and the provider is in-network. Though the ER visits that Hannah and I have had are routinely covered, planned surgery needs to be in-network. That’s on me. I need to know my plan much better. One of the pitfalls of being so damn healthy is that I rarely use my health insurance. (Is that what is called a false brag?)
Part 2, follows this story from Somersworth, NH to Kennebunk, ME as I deal with Big Medicine and Big Insurance sparring as they use me as the punching bag.