Good news first: My internist received a fax of the biopsy results from my endoscopy while I was there so even though I haven't heard yet from my gastroenterologist, I know that I definitely don't have celiac disease or pernicious anemia or whatever the third thing he was looking for was. All the biopsies came back "unremarkable." So that's good.
We also talked about the D-dimer test I got back a few weeks back that sent me to the ER for a CT to rule out a pulmonary embolism. I read at LabTestsOnline.org that one of the causes of an elevated D-dimer could be recent trauma, so I asked about whether my knee injury could be responsible for that test result. My internist said absolutely. OTOH, she also said it could be related to my elevated anti-Cardiolipin levels, which also indicate a clotting issue. So we'll see what the specialists think.
I also brought in a copy of this article, which Katie from Drew & Katie suggested I check out. I love the fact that Dr. Takano is totally open to considering anything I bring in and ask her about. She skimmed a little bit of the very long article, and agreed it sounded like something that should be ruled out. Since she also has wanted to send me for a chemical stress test, I asked about getting referred to a cardiologist. (My insurance doesn't require referrals, but I like to stay on the same page with my internist and I value her opinion.) Dr. Takano thought it was a great idea and picked out a doctor with offices at my favorite hospital.
That's when things got complicated. You see, our insurance changed on Jan. 1. I had figured, "Oh, it's Aetna. Everyone takes Aetna." And I didn't actually check into who was in their preferred provider network. Turns out, that favorite hospital isn't covered in-network. Oops. And neither was the practice the cardiologists she referred me to.
So I spent about an hour going through all my doctors in Aetna's search engine to find out if they're in network. All the providers I already see are, which is nice. Interestingly, my OB is a preferred provider, but the hospital she delivers at and performs procedures at is not. Sigh. I called the Aetna customer service folks to ask about that and was told that I can go to any emergency room and be covered at in-network rates, even if I'm admitted. However, if I had a scheduled c-section or needed to be induced or have another scheduled procedure, it would be covered at out-of-network rates for the hospital part of the bill. But the OB would be covered at in-network rates. Is that crazy or what??!
The other interesting (in a bad way) thing about this new policy? I thought we got a good deal because our out-of-pocket maximum went down from $1700 per person in 2008 to $1100 per person in 2009. The tricky part? The fine print says "flat-rate fees" such as office visit co-pays do not count toward that maximum, nor, when you reach it, do you no longer have to pay those co-pays. And since they raised the co-pay for specialists, as well as our prescription co-pays, I'm now worried that our medical bills are going to be higher than anticipated. Not that we had much of an idea how to anticipate, other than trying to pad that part of our budget as much as possible, but this kind of sucks.
Other noteworthy minor details:
- I got copies of some lab tests that I'd been given verbal explanations of but not paper copies. Included in there was the last serum protein electrophoresis (SPEP) test to check on my levels of monoclonal immunoglobulin. They're still low enough that no one is freaking out or suggesting I hurry to a hem-onc again. But they've gone up slightly since I was last tested in April 2008, when it was essentially the same as it had been when they were first detected in October 2007. So, while I don't think it's anything to be alarmed about, I'll be talking about it with the immunologist when I go back in late February. And I'm guessing that means they'll want to continue testing it every 6 months rather than stretching it out to an annual test.
- Both my platelet count and my CRP (which is a marker of inflammation) have both gone up some. They were already elevated three months or so ago, and they're a bit higher than they were. Interestingly (to me at least), while the CRP is higher than it was when I was tested previously, my ESR (a different marker of inflammation) is not quite as elevated as it sometimes is. (It's still three times what it should be, but it's been higher in the past. It fluctuates, as apparently all my various oddities do.)