Williamfuentes.comAfter fainting from the shock of PRP treatments pricing ($2,000!) which is still considered experimental to the Ins. company and so are NOT covered, my doctor prescribed a month of Physical Therapy.  Hmm .. I kind of don’t believe in this form of medicine.  (Sorry PT friends,) but the whole idea of stretching, massaging, electrical stimulation, ultrasound wave relief, blah, blah … well it goes against my black and white “cut open & cut out problem/stitch up problem OR Give medicine, feel better” ideals.  But with the incentive of full ins coverage & my doctor’s belief in it, I’m inclined to be persuaded.

I live in NY so there must be an open-minded girl chained & muzzled somewhere inside of me.

I had my first round of PT on Friday.  It was predictable BUT, I’m going to give it the respect of a full month as my doctor has prescribed.  I’m a VERY impatient person.  VERY IMPATIENT.  My fear is this is all wasting time & that I should have spent the $2K, gone straight to the PRP treatments & saved a month of recovery.  I guess time will tell. 

Insurance … let’s vent about health care for a second without getting too political into Universal Health care, ObamaCare, or anything like that.  That’s a different blog.  I just want to bitch how STUPID MY insurance is… So I went to my shoulder doctor because, I had a problem.  He figured out the problem and prescribed a solution.  My insurance however found NO VALUE in this.  NONE.  What DO they find value in, you may ask?  Turns out I would only be covered for Physical Therapy IF:

  • I had already had surgery.  *Which would cost them a BUTTLOAD and I’m TRYING to avoid OR
  • If I’d gone to the ER for my shoulder. *huh?

IF neither of these occurs, I’m not covered.  The agent said…

Halloween 2011“Go to the ER today, sign in for your shoulder, they’ll record that you’ve been to the ER for your shoulder, THEN we’ll cover you.”

The agent and I both agreed that I’d taken ALL LOGICAL steps to be covered for the PT and we BOTH laughed in that


way at the ILLOGIC of my need for the ER visit.  So it probably cost my insurance a couple grand, but I went to the ER this week, paid a $50 Co-Pay, told the ER doc my situation, she belittled me & then my ins company for wasting her time, the ER’s time, and the insurance company’s money, BUT now I’m covered.  STUPID!

(For the record, I am COMPLETELY aware I didn’t waste the insurance company’s money.  I will eventually PAY for this unnecessary ER visit and all unnecessary red tape they impose on patients, when they raise my insurance premium next year to keep their profits consistent.) 

A few interesting observations from the PT doc.  My posture is hurting me.  I hunch my shoulders forward and this weakens my shoulders.  So she had me squeeze my shoulder blades together and TAPED them like that!  This feels Weird.  I walk around like a drill sergeant.  I guess that’s good.  Smile

I’m unconsciously changing my left arm’s natural functions.  For example….Unbeknownst to me I hold it in close to my body as if it were in a sling.  (The doc pointed it out to me in the mirror as I did it.)  My left shoulder is sagging lower than my right shoulder.  Also, instinctual I grab for things with my right arm now that are in reach of only my left one.  So part of my PT is to begin incorporating my left shoulder in life again.  Regain it’s strength and normalcy. 

So far, PT grade:  A questionable C-

WilliamFuentes.comNow for the good news.  I am allowed to play 2 hours of pool per week!  HOORAY!!  I know this isn’t a lot but it’s better than no pool at all.  This was the best news EVER!  I missed the Predator Tour this weekend since tourneys are too long and strenuous but it’s only for a month I’m out of competition. I’m just thankful I can play a little. 

Off to league for my little dose of <3. 


~ by g2 on November 6, 2011.

8 Responses to “Im(Patient)”

  1. OMG Gail…..i had no idea you were going through all of this! God love you, and i will be praying for God’s healing hand to cover you with His Love and bring you to a speedy recovery.


  2. UNBEEWEEVABLE………….Yep the insurance companies rule the world…………My Dad, whom is passed on 15 years now, once said to me………”If you or anyone you know is associated with or works for an insurance company, you are essentially a CROOK…………I laughed and giggled when my dad said this………but as my years have matured……I have realized that yes, they are CROOKS.
    Hope your healing goes well………….I think I told you that I had a similar injury…… was the muscle in the rotator cuff that I had strained several months back. The Mrs. rubbed my shoulder everynight before going to sleep with ICYHOT. give that a try ………costs a lot less than $2,000. C U WHEN I C’s U.

  3. You may have already seen this NY Times article about PRP:

    Several years ago I had a problem with back pain. A wise friend pointed out that the top front of my thigh muscles simply needed stretching (partly because I sit so much every day) so my back could straighten up. He had me do an exercise that runners do — push the leg back to stretch that muscle out. After doing that often for a week or 2, my back soon became fine and I never had a problem since.

    Have you tried stretching the top front muscles of your chest? (Pull your arms back from time to time, feeling the muscles stretch.) Forgive me if this is already what they were having you do in physical therapy.

  4. Oh Gail,
    Although I feel your pain , I did have to laugh. Love your style of writing and find it so amusing. When you deal with anything regarding insurance companies, logic must be thrown out the window.Glad you have the permission to start playing pool again even if it’s only 2 hrs. per week. YOu’ll make the most if it, I’m sure!
    Hope to run into you and Tony very soon,

  5. Gerard, I’m gonna tell TR you said he has to rub my shoulder with Icy Hot each night! Thanks!! Robert, I hadn’t seen that article and I really appreciate you attaching it to the post. I’m hoping the PT will eliminate the need to even exercise the PRP option! I have been instructed to stretch my shoulder blades and strength that entire area so my shoulders are better supported. But I will ask about the pec muscles too. Thanks!! Eileen, you are such a doll. When on earth am I gonna see you again?!?!? Miss you.

  6. hi Gail….had you on my heart and wanted to say i’m praying for you my friend. Your so special and you mean the world to so many people! Your attitude and outlook upon any given situation is positive and motivating. Thanks for all the Love you share with everyone and smiling that wonderful smile God loves you and so do I♥

  7. Gail, I am so sorry I spoke too early. The Facebook link pointed directly to your article only, so I had no idea that more complete details of your shoulder pain were written in your earlier article. My suggestions were for the “hunching over” effect that you mentioned, not your rotator cuff. So now I am not confident about giving proper advice. But I can relate my experience.

    A few years back I slipped on an ice patch while walking to our Billiards Cafe, and I landed on my shoulder. I felt pain immediately and I thought maybe I broke something. But I waited a few minutes and figured it was not broken bones. I followed my body’s instinct of “don’t irritate the shoulder”. I gave it time to relax and heal. People told me tendons and muscles need time to heal. It took a couple months before I noticed a change for the better. I didn’t feel like a full person for months. But by 6 months I hardy felt it. After maybe a year, it was like it never happened.

    Google got me to
    which might or might not be stuff you’ve already seen.

  8. Came on here to give you support for the procedure scheduled for today, but now I guess its not happening. Went to Castles on Saturday to show support for you & my friends that attended, but you wasn’t there =( . Oh, well…did meet TR & he gave me the news of your status. I was sad @ 1st, because you won’t be able to play as much, but then again you get some time & that’s better than no time. Glad to hear that they’re not taking you away cold turkey & that you’re willing to try alternative methods. Stay open minded.

    Nice Halloween Costume…you guys are funny.

    Oh here’s a quote that I found on patience for you:

    Have patience. All things are difficult before they become easy.

    Read more:

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