Dealing with health insurance requirements complicates my care

I generally like my health insurance plan, because it covers a lot of what I need. But I have Cushing’s disease, which is complex and can lead to complications with my insurance coverage.

Here’s a recent example:

Step one: I had a regular checkup with my OB-GYN. Because I have Cushing’s disease, she wanted to make sure I was well taken care of, which I appreciated. So she referred me to a high-risk OB-GYN within the same network, and I scheduled an appointment.

Step two: I met with the high-risk OB-GYN, who discussed the risks involved with my pregnancy, and then reviewed my past lab work and MRIs. She noted my visual issues and said I shouldn’t have to deal with the constant visual snow I currently experience. She recommended I meet with a neurotologist to see if they could help.

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Step three: I tried to make an appointment with the neurotologist but was told that my insurance provider won’t approve it because I needed a referral from my primary care provider. To me, that doesn’t make sense because I’d already been referred by a high-risk OB-GYN.

Step four: I tried to get a referral from my primary care physician in New York, because I recently moved from there and haven’t had a chance to get a primary care physician where I currently live. Primary care physicians are great, but I meet with an endocrinologist every six weeks and an OB-GYN every month, so I don’t really need to be monitored further.

Step five: I was told the primary care physician needed to be in state here in Michigan. If I didn’t have one, I’d have to pay out of pocket for the neurotologist appointment, which would cost over $700. Inevitably, I had to cancel the appointment and need to reschedule it when I have a local primary care physician. I’d gone through all that effort without being able to see the doctor I needed.

I hope to figure all of this out in the future, but I’m pregnant and disabled, and have several appointments already scheduled. Even if I do see a primary care physician, there’s no guarantee I’ll get the referral I need. Once the baby arrives, things will become even more complicated.

I’m grateful for the insurance coverage I have, but I also know that insurance companies are driven by profit. I’m pretty sure my company is simply following its protocol and didn’t look at all my medial charts and history.

I hope that someday, we’ll all be able to see the doctors we need to see, because it shouldn’t be this difficult. I’ll keep you updated if I ever get that neurotologist appointment I need.

You can also follow my journey on TikTok and YouTube.

Note: Cushing’s Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Cushing’s Disease News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to Cushing’s.