1. INSURANCE (as defined):
   Noun
   1. A practice or arrangement by which a company or government agency provides a guarantee of compensation for specified loss, damage, illness, or death in return for payment of a premium. Synonyms: indemnification, assurance (financial) protection, security, coverage.
   2. A thing providing protection against a possible eventuality. Synonyms: protection defense, safeguard security, hedge, precaution provision, surety, immunity, guarantee, warranty.

     In August of 2016, I received a letter dated August 3, 2016 from my insurance company, CIGNA. This letter was sent to me in response to a request from my physician regarding a medical order made by him for an MRI of both of my legs due to severe knee pain, and a mass that was found in my left leg just above my knee. The letter stated:
      “After reviewing the information we have, we’ve determined that this service is not medically necessary.” Enclosed with the letter was information for an addressee: eviCore Healthcare   730 Cool Springs Blvd Suite 800   Franklin, TN 37067
     When I called my insurance company, I was advised that eviCore was a partner company that handled approvals and denials for CIGNA. CIGNA offered me NO resolution, nor did eviCore, so I was forced to contact the company’s third-party administrator (TPA). The TPA approved the MRI and the MRI was performed. It was found that I had damage in both of my knees that required surgical intervention, and that there was an unidentified mass above my left kneecap. I had surgery on the left knee in September of 2016 to repair the damage to that knee, and to remove the mass for biopsy. Once the pathology report was returned, it stated that I was diagnosed with a disease known as sarcoidosis. Sarcoidosis is an autoimmune disease wherein the body produces granulomas (growths made up of white blood cells that mass together), causing the immune system to malfunction, leading to severe inflammation, joint/ muscle/ bone pain, swollen lymph nodes in the chest, lungs, groin, armpits, lesions on the skin; and since it is also a connective tissue disease, it can attack EVERY ORGAN IN THE BODY. There is no cure for this disease. Some patients experience short periods of remission, but the disease does return, and flare-ups can last for days, weeks, months, or longer. It is a severely painful disease, and while the disease itself is not terminal, complications from this disease can be fatal. Treatments for sarcoidosis are dangerous, and cause many adverse side effects – some worse than the disease itself, so patients rely on pain medication to get through their daily lives.  I was diagnosed with this disease through a biopsy, however had I not fought to get the MRI imaging approved, I would not know what is wrong with me because, A) sarcoidosis cannot be diagnosed or found with a blood test, and B) because as eviCore stated, the service was not “medically necessary”. I am currently awaiting a date for surgery on my right knee for reasons which are indicated below, but since this time, I have developed more granulomas from the sarcoidosis.
     In the interim of the surgery on my left knee, I was also experiencing severe pain in both my shoulders that ran down my arms and into my hands, and pain in my hips, ankles, and feet. Through two series of x-rays and a multitude of bloodwork, it was discovered that I also have osteoarthritis. Osteoarthritis is also a disease with no cure that affects the joints, causing unbearable pain, and malformation of the joints. Wanting desperately to avoid surgery, I attempted (on the advice of my physicians) cortisone injections, physical therapy, and a suprascapular nerve block, none of which improved my condition. On the recommendation of my board-certified pain management physician, I was to return to my orthopedic surgeon, as in his opinion, I had expended every avenue to avoid the inevitable. 

     I went back to the same orthopedic surgeon that performed my knee surgery.  During the appointment, a set of x-rays was taken and an MRI was ordered to enable the surgeon to see the deep tissue in my shoulder prior to surgery. At the end of April, I received a letter – again from CIGNA and eviCore – dated April 20, 2017. The letter stated:
      “After reviewing the information we have, we’ve determined that this service is not medically necessary.” The letter also states: “Treatment might include: 1) rest, ice, wraps, and/ or propping up of your affected body part, 2) drugs that treat swelling and/ or pain, 3) oral or injected steroids, 4) a home workout program and/ or a formal in office workout program, 5) bracing, splinting, and/ or casting, and/ or 6) injected treatments. Your records do not show that you failed to improve following a 6-week trial of treatment.”
     Please note: this letter was received AFTER a cortisone injection in each shoulder, a suprascapular nerve block on the right shoulder, as the cortisone injection failed to provide relief and in fact made my shoulder hurt worse, almost four weeks of physical therapy, which I was advised to cease by my pain management doctor, because it was reducing my range of motion and increasing my pain level, and several sets of x-rays. Also, I did attempt on the “treatment recommendation(s)” of the insurance company to take a prescribed anti-inflammatory drug called Lodine, which caused me to have transient hypertension, and I am now on blood pressure medication as a result and was ordered to cease taking the Lodine IMMEDIATELY by my cardiologist.
     A second time, I was forced to contact my TPA to have the MRI approved. Please note: as of the date of this composition (June 17, 2017), I am almost three weeks post-op on my shoulder, as it was found that I had a full thickness rotator cuff tear, shoulder impingement syndrome, and osteoarthritis so severe on my clavicle that it had to be scraped. But again, the service was not “medically necessary.”
     CIGNA is my health insurance company. I have never been late on my premium payments, as they are automatically withdrawn. I pay them to provide me a service to ensure that I receive the best possible care under the law. By that rationale, THEY WORK FOR ME! Their job is to ensure that I receive the care I need as ordered by my doctors, who are ALL board-certified in their fields. I was not abusing medication. I was not requesting medication. What I was requesting was simple testing – tests that were necessary for my physicians to make a proper diagnosis and ensure that I received the necessary treatment I am paying for and thus deserve. This test was not going to cause me to overdose, nor would it cause me to drive and risk another person’s life.