My wife was supposed to have a brain MRI today
(Saturday), but we're hung out to dry until
after the weekend because the insurance company's
consultant (CareCore National) didn't come
through with the approval in time. In my
frustration, all I'm left to do is write about it.

Approval won't be automatic, even for the
head of neurology at a major university. That's
what his front office tells me. So maybe I should
take bets on whether approval will be forthcoming.
Here's the data for handicappers:

The neurology chief ("Doc" for convenience)
had gotten approvals for both thoracic spinal and
cervical spinal MRIs. In addition to these, he had the
results of somatosensory evoked potential tests (SSEP)
for both upper and lower extremities, done at the
university, and an EMG, done by a provider to my
wife's regular neurologist. The negative results on
all of these that led Doc to order a brain MRI. He
told us that if that proved negative, he would re-do
the EMG and if that wasn't informative, would order
a spinal tap.

Interestingly, Joan's regular neurologist was
denied the two MRIs that Doc got approvals for.
(He had previously gotten a lumbar CAT scan and
the above-mentioned EMG.) This led me to wonder
whether CareCore was influenced by the prestige
of the requestor. At any rate, the denials are
why he referred her to Doc.

Now the symptoms: Joan is 58 and has developed
a combination of permanent stiffness and
episodic spasms in her left leg. The onset was
sudden; she woke up one morning with what I call
a "charley horse." This has happened to her before,
but this one didn't go away. The spasms, which
seemed to occur randomly a few times during the
day, left her in pain. To shorten a two-month-long
story: Her regular neurologist, who had been
treating her for peripheral neuropathy in both
feet, put her on an array of pain-killers and
muscle-relaxants. By now she's a drugged-out
zombie most of the day who can just barely walk
with a cane. The spasm episodes have slowly increased
in frequency and now seem to be triggered by simply
waking up or being surprised. This reminded me of
what I've read about cataplexy.

Bets, anyone?

Joan's mother, not surprisingly, asked me this
morning why I don't just risk it and pay for the MRI
myself and resolve billing issues later. My reason
for waiting is that a denial by CareCore will be,
in effect, a free, if forced, second opinion. Doc's
front office says that following a denial is the
"peer-to-peer" stage. My brief encounter with Doc
has made me decide that I want as many professional
minds applied to Joan's problem as I can get.

--
Charles Packer
mailboxATcpacker.org
http://cpacker.org/whatnews