Doug will remember the first time I blew out my knee — we were at a driving range up on route 83 (Ballybunion, Ballykissangel, BallyMcBeal, something like that), and during my backswing I went down like I’d been shot. My knee had twisted out of alignment with a sickeningly loud, wet pop, and popped back in again while I was busy falling over. I was able to drive myself home from his house (he drove my little Justy from the range back to his place — it was a funny car to drive with about three inches of motion on the clutch in all, so it was an exciting drive). I went to the ER from there, got a big brace and some good drugs and a referral to an orthopedist, and eventually life got back to normal.
I did it again on Monday while hitting balls at the grass range at Willow Hill Golf Course. I was there with my buddy Eric, and the same thing happened. I went down in a heap (unfortunate, as it had rained the night before — I was pretty wet and mossy for the rest of the day), and spent about five minutes on my butt assessing whether I could then go play. Judging from my doctor’s expression later, my choice to go walk nine anyway was not what you’d call “doctor recommended.” Anyhow, I think my fear of doing it a third time actually fixed my swing a bit (I tend to torque around on that left knee far too much, relying on it to make up for some of the snap that my upper body is lacking in my swing). We didn’t keep score as it was my first time out in a year, but of nine holes on a windy links-style course, I think I had four bogeys. No pars and one or two blowout holes, but it was a very good time.
So I iced and wrapped it when I got home, and figured that was that. But Monday night I was up much of the night with it, and found it very difficult to get down the stairs Tuesday morning. So I made a doctor appointment. Dr. Kirchoff checked it out, waggled it this way, wiggled it that way, and thought I may well have torn a ligament toward the front inside of my knee (judging from the diagrams I’ve found, I think she was talking about the medial collateral ligament — there was something about the meniscus in what she said, too, but I can’t find a term like that on any of the stuff I’ve found so far). Anyhow, she ordered an MRI. I called and scheduled it from the car after that appointment, wanting to get this back under control as soon as I could. That’s when the fun began.
I had a call this morning about it from the hospital’s insurance people — apparently our insurance company typically takes two to four days to approve or deny this test, so the nice lady warned me that I might not get approval before the appointment I made, and that they recommend that I cancel the appointment until approved. She said she’d call back before the end of the day.
Sure enough, she did. She was great — sympathetic, informative, and so on. But her news was bad — our insurance company had (in record time) denied the MRI on the grounds that four to six weeks of more conservative treatment had not been given first. I am supposed to ice it for four to six weeks and take Advil regularly (and document it), and if I’m still debilitated after that we could resubmit the request. She told me that they might be willing to expedite things if I had an X-ray first.
X-rays don’t find torn ligaments. They don’t find torn or frayed meniscus problems. They really ONLY find broken or chipped bones or major alignment issues, which are clearly not the issue here. So in order to get my MRI, I have to do four to six weeks of ice and Ace bandages, or do the X-ray dance in hopes of getting my MRI in four weeks instead of six. By that time, evidence of damage might be harder to find, or a tear might start to heal (with scar tissue that could otherwise be avoided).
Bless her heart, the nice lady who works for the hospital spends all day every day toggling back and forth between conversations with insurance companies and patients. And she probably has to argue with the former and provide the latter with crappy news more often than not. What a job.
Anyhow, it seems to me that if my doctor orders a test, it should be approved. If my doctor develops a history of unnecessary tests, that’s one thing. But a blown knee is a blown knee, and if I’d gone to the ER instead of my doctor it would all be done by now (at much greater cost to the insurance company).
All of this is exacerbated by the fact that our deductible is $1000 each — Lizzie has burned through most of her deductible already because of some funky wrist stuff, but I’m still sitting pretty with all of my balance. So the MRI likely would have cost the full deductible, but adding the X-ray at the beginning sure as hell would have. And by adding the irrelevant X-ray, you’re only adding to the part that the insurance company will then have to pay for if the MRI is then approved. I just don’t get it.
I decided (pending any urgent information from my doc) to just wait it out. If I heal sufficiently by four weeks from now, I’ll just be done. If not, I’ll pursue it. But this X-ray prerequisite is ridiculous. It’s no wonder insurance companies have the reputation that they do. Given that I’ve decided to limp about and self-treat for six weeks instead of trying to cash in the coverage we pay for with every paycheck, I’d say our confidence in the system is shaken.
Anyhow, I’m now sitting in my office with my big bulby knee, wrapped tightly with a cold pack inside. Two days of icing and wrapping hasn’t helped — only 26-40 days to go before I can try to go get diagnosed again. Crazy.