Day 14 - Insurance Annoyance

I've been icing and elevating, and my heel is feeling ok -- no more painful than it was before, mostly.A twinge now and then, but doing ok. I'm hoping that this is a good sign; that this means I didn't rupture or tear anything off my heel.

At any rate, when we called the surgeon on Saturday night, he said he wanted an MRI. So, the order went in on Monday and the lovely dance with the insurance company starts. The scheduler at the office calls to tell me that insurance denied the MRI and would not give pre-approval for it. Ookay. Apparently it went to them, then to their physician review process, andtheir physician decided that it wasn't necessary and an xray would do.

Um. no. We know I have bones in my foot, but an xray will not show the surgeon if the reconnected tendon is still attached. It won't tell anyone anything except to reconfirm that my foot isn't broken. We know that. So, reconsideration after trying, again, to explain that I'm 10 days post-op and had an accident and stepped on the foot and possibly ripped loose all the tendon attachment points. I talked to them, Mark talked to them, and the scheduler talked to them. Nope! Not medically necessary, an xray shoudl be just fine for diagnosing issues with a sprain/strain.

Wait, what? No, not a strain, you idiots. A post-op accident where I may have torn the freaking tendon loose from the repair. We're trying to determine the patency of the Achilles re-fastening. Back to the drawing board with the insurance company and the medical review group. Seriously, it was like a bad game of Telephone. How the ICD-9 code for 'achilles rupture' became 'strain/sprain' is not quite clear. Well, obviously, the insurance company doesn't want to pay for an MRI if they don't have to. SO they come back with "needs to have a physician evaluation and xray first".

Sure, now I have an appointment for an xray and time for the surgeon to look at me, unwrap my foot, and then note "needs MRI" in the chart. Oh, taht was useful! Dr Leonard dutifully prodded my ankle, noted that the tendon seemed to have the same tension in both heels, and didn't have any obvious injury. And then laughed and said, "But I can't tell anything at all until I see the MRI".

This time, the scheduler called and walked down the hallway with her headphone on to grab the doc when she got the review company on the phone. "Here! I have my physicians, get yours on the phone". It took a total of three minutes for my surgeon to explain just why the other guy was wrong and this was required. Voila, MRI scheduled for that afternoon. Seriously, that was way to complicated for a necessary test (with a pretty hard time limit).

I will say that of course, even if the insurance had denied it yet again, I woudl have had the MRI today. It's not something I"m going to skip just because they want to be pissy. It's necessary and I don't want to repeat this all in six months if we discover that the tendon attached improperly or healed badly.

THe doc said he had a patient last year who did the same thing and never told him. ONce you rupture the tendon, there isn't any actual pain -- like cutting a phone cord: sound one second, then nothing. So the repair shifted, healed badly and too high on the heel and took several hours to fix later on. I really don't want that. I really don't want ANY re-op, and I'm hoping that this doesn't need it. But I am going to do everything to be sure before we write this off as "Robin is a Klutz, please note that in her chart."

The MRI was uneventful. Took longer than I thought it would, with my foot in a very awkward position. You have to be utterly still, so they pretty much strap whichever part of you they need to scan into a brace with foam and velcro.  They have a standard foot/heel brace; nope - can't actually flex my foot far enough to get it into the brace and still scan it all. He tried a round frame that they use for whole foot or knee or hand; nope -- my foot doesn't quite fit without bending it down, can't do that either. It's neutral position or nothing. One last try, a big foam envelope thing that he could pout my foot in  on its side and then fasten it down with another layer and velcro. Felt like putting it in a waffle maker.  The scan of my heel/ankle took about 25 minutes once we got things  velcroed in and me slid halfway into the MRI machine. I had though it was faster, but Mark said that I must have been thinking of the CAT scan machine, which is super fast. This is slow and loud, but turns out pretty 3d images. We notified the radiologist and the surgeon and headed off to  have a burger.

I should hear about the results in the next day or so, and have a default follow up set for next week (it can take 3-5 days to get things read normally, but my surgeon is pretty antsy to figure this out, since if it needs to be re-done, doing it sooner rather than later is a big deal.) If I do need the repair re-done, I assume we'll schedule it for next Tuesday. Oh, fun. Start from square one. I sincerely hope not.

So, think good thoughts that my MRI is clear and that I aggravated this, not damaged it. Every time I slightly twist, or slip and tense my foot, or accidentally touch my foot down, it hurts, so I'm ready for this to be resolved!