Through out the years of my daughter's journey with fibromyalgia I have learned many, many new things. Obviously, I learned about fibro which I had never heard of before my daughter was diagnosed, I learned there are alternatives to "traditional" (aka pills and shots) medicine but one of the most surprising things I learned is how the medical system works.
When my daughter first started having symptoms of pain she went to her regular doctor. The usual misdiagnosis of muscle strain, carpel tunnel, tendonitis etc followed. Her regular doctor finally referred her to a specialist, an Orthopedic Doctor. I looked it up, it takes 13 to 14 years to become an Orthopedic surgeon. They have to obtain a bachelor's degree, attend medical school, and complete a residency and fellowship. The Orthopedist runs all kinds of tests and finally determines that my daughter has fibro. The doctor, with his years of school, training and being a practicing specialist determines the best course of treatment. Great news, right? Oh no, not yet, first you have to get approval from the INSURANCE ADJUSTER.
Thats right, I said "get the approval" from the Insurance Adjuster. The Orthopetic Surgeon prescribes medicines and tests and therapies to help my daughter's pain but first the Insurance Adjuster from the Medical insurance company has to approve her treatment. So the Insurance Adjuster does not approve of the course of treatment prescribed by the Orthopedist or only approves part of the treatment or approves a lesser treatment that the Orthopedist believes will not only not help but could actually increase the pain. This can't be right, it makes no sense.
I looked up the education requirements for becoming an Insurance Adjuster. They are required to have a "High School Diploma or GED and one year of customer service experience". Are you kidding me??? Customer Service Experience??? Do they mean like the customer service desk at Walmart???
But we shouldn't worry because the Medical Insurance company requires that the potential insurance adjuster "Completes required training program which includes the overall instruction, exposure, and preparation for employees to progress to the next level position. It is a mix of online, virtual, classroom, and on-the-job training. The on the job training includes practice and execution and coaching" I am not joking, I got this from a current job posting.
So basically, my daughter's medical treatment is being determined not by the Medical doctor with 14 + years of school and training but by the Medical Insurance adjuster that at least has a GED and one year of dealing with pissed off customers trying to return items to Walmart the day after Christmas!!!
If I didn't have a daughter with Fibromyalgia that has been turned down for treatment prescribed by her doctors by the Insurance adjuster and I read this post I would never believe this could be true. I have seen first hand doctors tell my daughter that they wanted to do X, Y or Z treatment but they knew from past experience that the treatment would not be approved. Now of course you can pay out of pocket for the prescriptions, treatments and tests as prescribed by the doctor and believe me I tried for as long as my money lasted, but at some point you run out of money.
In our case we were lucky. The medications were not working for my daughter and as I have said in previous posts the meds were actually causing damage to her liver so I learned another new thing. Pills, at least for my daughter, were not the answer so I learned about topicals and now make Mr Crowley's Rubs that really work and help my daughter's pain and almost as important we do not have to get approval from any Insurance Adjuster ever again.
Until next time... Mrs. Crowley
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