Sonya was no stranger to hard labor and the occasional back pain, but the pain that brought her to our clinic was like no other backache she had experienced before. It was sharp, focused in the middle of her upper back and it had appeared instantly as she leaned over to pick up her grandson, Ivan.
Her x-rays showed a compression fracture and her bloodwork was normal. Her bone density had been borderline about four years ago, so it seemed this probably was “just” an osteoporotic fracture and not a sign of anything more ominous. The MRI did not suggest cancer. Reassured, she took pain pills and limited her activities for the next several weeks, but the pain was unrelenting.
Sonya seemed to be a good candidate for a vertebroplasty, a procedure where a type of cement is injected into the collapsed vertebra. I referred her to Joe Dugan, an affable orthopedist with a special interest in vertebroplasties. Joe agreed and went on to schedule the procedure.
A week went by and Sonya didn’t hear anything. Then yesterday I got a message that I needed to speak with a physician reviewer about her procedure.
After several minutes of phone tree tribulations, it was clear that I would not be able to get anywhere with Consolidated Insurance, since I did not have access to Sonya’s policy number. All I had in my message was the case number, but the automated telephone attendant wouldn’t accept that number.
Finally I gave up and asked Autumn to get me a better number for the physician reviewer, which she did, effortlessly.
The ensuing conversation made me nauseous. The jargon-swinging doctor at the other end of the line (actually, he faded in and out, and might have been on a cell phone) asked me if Sonya had osteoporosis.
“Well, she suffered a compression fracture picking up her grandson”, I answered.
“Has she had a bone density?” he asked.
“A couple of years ago”, I answered, “showing osteopenia”.
“Unless she has osteoporosis on a bone density test or cancer, her policy doesn’t cover vertebroplasty”, he said.
“But why else would she get the fracture, not skydiving or anything, but just picking up her grandson?” I asked, my head spinning. “Is a picture of her hip and lumbar spine really going to prove to you she doesn’t have osteoporosis in her upper back when she has had a spontaneous fracture?”
“I’m sorry, without a bone density to prove it, we cannot cover the procedure”, he said again.
The man was not acting or thinking like a doctor. There was no empathy, wisdom or compassion. I felt like I had watched a court room television drama, where the bad guy got off on a technicality.
Sonya’s insurance company is a large national for-profit conglomerate.
She will have a new bone density test, but the bigger question remains: What is osteoporosis? Bones that break easily or bones that appear thin in pictures? Are we treating patients or pictures of patients?