Raising Boys

Health care provider issues October 28, 2005

I just ended an exasperating (on my part, at least) phone conversation with a representative of the health maintenance organization (HMO) providing health insurance to our company. Our HMO, ValuCare, had initially refused to cover a fasting blood sugar (FBS) test that my gynecologist recommended I undergo.

The silly reason given by our HMO was that the doctor who recommended the test was not in ValuCare’s list of accredited doctors.

This is not my first experience with the unreliability of this HMO. In August, it refused to honor my sick son’s coverage for reasons it only knows. Last week, I brought my sons to Valucare’s accredited testing center for the yearly regular medical check-up, which would only run from October 13 to 31, only to be refused by the center because of some fiasco that was either the fault of my company or the HMO or both.

I told the ValuCare representative that the doctor had been my obstetrician-gynecologist for years, had delivered my second baby, and already knew my medical history enough to confidently treat me for my polycystic ovaries.

On the other hand, I further told her, my company is notorious for switching HMOs on a yearly average, and, if I accept her reasoning, should be how often I change doctors, too. Anyway, your company is not paying for my consultations with my doctor, only the test that she recommended. The least you could do is pay for that.

Finally, reason dawned on the ValuCare representative and she said she was going to make an exception and allow coverage of the test.

The FBS will measure the amount of sugar in the blood and determine if there’s any anomaly.

My gynecologist recommended the test because of my polycystic ovaries, which was discovered during a pelvic ultrasound two months ago.

In my research into polycystic ovaries, and why some women who have it sometimes do not show symptoms of Polycystic Ovary Syndrome (PCOS) while others develop them, I have learned that one of the key features of the illness is the inability of the cells in the body to accept insulin. This results in higher levels of insulin remaining in the bloodstream and contributes to lack of ovulation, high androgen levels, infertility, and early pregnancy loss in women with PCOS.