After I got settled in Kentucky and got a referral to the second orthopedic surgeon, Dr. Brent Morris, I had renewed hope. This guy came highly recommended by the first surgeon, and from my own research, I could see he was held in high regard by his current and former patients as well. I met with him in late 2022.
I found him to be professional, knowledgeable, experienced, and compassionate. What happened next instantly shattered that renewed hope. Paraphrasing here because I don’t recall word-for-word what he said:
“I’m not the surgeon you need. I can’t help you because you have a rare condition called scapular dyskinesis. That is not my specialty. But I know who to send you to.”
At first, I was angry and heartbroken, and I wanted to break down and cry right there in the exam room. With tears in my eyes, I said to him, “So you can’t help me?” He replied, “No, I’m not the guy you need. Maybe I used to be the guy, but I think this is beyond my level of expertise. But don’t worry because the guy I’m sending you to is the best for this condition.”
In complete shock, I walked out to my car in a daze. I called my husband, and through sniffles and sobs, I told him what happened. It had already been over 2 years when I saw Dr. M that day.
Over two years of failed treatments, countless appointments, a dozen prescriptions, growing limitations, worsening pain and consequently, broken sleep. The pain made it hard not only to fall asleep but also to stay asleep, as I would often wake up in the middle of the night in intense pain.
Upon reflection, and after many frustrated tears, I realized I respected his honesty and humility. Renewing my resolve, I called the office of Dr. Jeffrey Grantham, the orthopedic surgeon Dr. M referred me to. My heart sank a little when I learned he was not in network with either of my insurances. I knew what that meant…come out of pocket for out-of-network costs, if the insurance company would even authorize me to see him.
Then, as I read the provider notes from Dr.M, I wept once more in gratitude. Based on my experiences, such compassion and diligence for patients is far from the norm. It is a unicorn in the medical world. He wrote: “I believe it is critical this patient sees Dr. G and his team.”
In disbelief, I reread that line twice more. He was trying to help me however he could, even though he wasn’t the one who could fix my shoulder. And that was exactly the pick-me-up I needed to keep fighting.
Did he know of the insurance battle I would likely have to fight to see Dr. G? Or did he merely see the pain and desperation in my eyes when he said he couldn’t fix me? I’ll probably never know, but I am certainly glad such amazing doctors exist. I wouldn’t hesitate to recommend him to people with other shoulder problems.
Let’s ponder that concept for a moment, shall we? If there were more doctors like that, who are willing to go above and beyond for their patients, think how much faster and more efficiently patients could be treated!
If we didn’t have to choose between sinking ourselves in debt for out-of-pocket costs or suffering for years whilst jumping through a crazy amount of insurance hoops…if we could just see the doctors we need to see, right away. What a beautiful, more functional world that would be.
If only we had more physicians that actually care about their patients…the ones who see people and not just dollar signs. If only insurance companies were less ruthless, and covered the actual doctors and treatments that people need and don’t cause further harm. If that were reality, maybe I wouldn’t still be sitting here in pain as I type this, 3 long years later.
On comes the insurance battle. It’s truly sad that it has to be a battle. That on top of dealing with chronic pain and jumping through numerous medical hoops akin to a sick circus act, we must also fight for the treatment we needed all along.
I discovered that my first insurance company would not authorize a referral nor pay a single cent for an out of network provider unless it is for emergency care. The second insurance provider flat-out denied my request to this out-of-network provider, with no option to appeal.
Alas, I was back to square one. Sitting and waiting for things to change. Dutifully calling the clinic every week, asking if they are in network with either of my insurances yet. The weeks drag on, as I’m struggling to get through the day in agony.
That meant alternating between indulging in any (healthy) distraction from the pain I can manage, and simply giving in to needing relief from the pain. That meant utilizing every tool at my dispense, to include pain creams, ice packs, heating pads, muscle relaxers, tennis ball massage, numbing agents, a TENS unit, anything but pain pills to take the edge off. At night, I was taking high dose sleeping pills to try to sleep at night. It felt all in vain, but what choice does one have?
FINALLY, in December of 2022, I get a win with my weekly phone call…the clinic has signed a contract with my insurance company to become an in-network provider. I was so happy I cried tears of joy and relief, I shouted, I jumped for joy. I would have done cartwheels across my front yard, if only my shoulder wasn’t effed up.
After many more calls between this clinic and my insurance company, I learned that the paperwork could take up to three months to be complete, giving them the ability to approve the referral. I thought to myself, I’ve already waited 3 years, what’s 3 more months? Thus, I continued calling week-after-week, hoping the referral process is complete.
Stay tuned for Chapter 3: New Beginnings.
Musecal Mind 