Thursday, December 07, 2006

This Is Not a Test

For the past few weeks, I've been scheduled for a nuclear stress test at 7:30 am on December 8th.

Today, at about 4 pm (just over 12 hours before I was scheduled to begin the test), I got a call from Dr. Mike's office telling me that Kaiser had refused to authorize the test, saying that there was no indication of a problem justifying such a test. The would authorize a basic echo-cardiogram, but nothing more.

Now I'm in the best shape of my life, no doubt--but at the same time, (a) I did have major heart surgery in April of 2000, (b) I still have a reduced ejection fraction, and (c) I have a mitral valve prolapse that seems to be increasing in severity. However, as Dr. Mike's assistant put it, Kaiser's new policy is basically "deny all testing but the most basic, deny all care but the most critical."

I called Kaiser to yell about it, but there's little satisfaction in yelling at a mid-level employee whose only job is to stop you from talking to the person who really made the decision to deny care. I also called the Georgia Insurance Commissioner's office to file a complaint, but since he just won re-election for four more years, I suspect I won't hear back from anyone any time soon (the only time you get prompt call-backs are in the month before an election, unfortunately).

Of course, I can try to adjust the budget to pay $3000+ out of my own pocket to cover the costs of the test. I may very well do that; I figure I'll take a week or two to decide, since the test has already been cancelled and it'll take a while to reschedule.

Meanwhile, I can no longer recommend Kaiser as a responsible insurer. For years, they've seemed to be a health-oriented insurance provider; now they operate more like the insurance companies in a John Grisham novel...

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