Woman Petitions Health Insurer After Company Approves — Then Rejects — Her Infusions
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When KFF Health News published an article in August about the “prior authorization hell” Sally Nix said she went through to secure approval from her insurance company for the expensive monthly infusions she needs, we thought her story had a happy ending.
That’s because, after KFF Health News sent questions to Nix’s insurance company, Blue Cross Blue Shield of Illinois, it retroactively approved $36,000 worth of treatments she thought she owed. Even better, she also learned she would qualify for the infusions moving forward.
Good news all around — except it didn’t last for long. After all, this is the U.S. health care system, where even patients with good insurance aren’t guaranteed affordable care.
To recap: For more than a decade, Nix, of Statesville, North Carolina, has suffered from autoimmune diseases, chronic pain, and fatigue, as well as a condition called trigeminal neuralgia, which is marked by bouts of electric shock-like pain that’s so intense it’s commonly known as the “suicide disease.”
“It is a pain that sends me to my knees,” Nix said in October. “My entire family’s life is controlled by the betrayal of my body. We haven’t lived normally in 10 years.”
Late in 2022, Nix started receiving intravenous immunoglobulin infusions to treat her diseases. She started walking two miles a day with her service dog. She could picture herself celebrating, free from pain, at her daughter’s summer 2024 wedding.
“I was so hopeful,” she said.
But a few months after starting those infusions, she found out that her insurance company wouldn’t cover their cost anymore. That’s when she started “raising Cain about it” on Instagram and Facebook.
You probably know someone like Sally Nix — someone with a chronic or life-threatening illness whose doctor says they need a drug, procedure, or scan, and whose insurance company has replied: No.
Prior authorization was conceived decades ago to rein in health care costs by eliminating duplicative and ineffective treatment. Not only does overtreatment waste billions of dollars every year, but doctors acknowledge it also potentially harms patients.
However, critics worry that prior authorization has now become a way for health insurance companies to save money, sometimes at the expense of patients’ lives. KFF Health News has heard from hundreds of people in the past year relating their prior authorization horror stories.
When we first met Nix, she was battling her insurance company to regain authorization for her infusions. She’d been forced to pause her treatments, unable to afford $13,000 out-of-pocket for each infusion.
Finally, it seemed like months of her hard work had paid off. In July, Nix was told by staff at both her doctor’s office and her hospital that Blue Cross Blue Shield of Illinois would allow her to restart treatment. Her balance was marked “paid” and disappeared from the insurer’s online portal.
But the day after the KFF Health News story was published, Nix said, she learned the message had changed. After restarting treatment, she received a letter from the insurer saying her diagnoses didn’t actually qualify her for the infusions. It felt like health insurance whiplash.
“They’re robbing me of my life,” she said. “They’re robbing me of so much, all because of profit.”
Dave Van de Walle, a spokesperson for Blue Cross Blue Shield of Illinois, said the company would not discuss individual patients’ cases.
“Prior authorization is often a requirement for certain treatments,” Van de Walle said in a written statement, “and BCBSIL administers benefits according to medical policy and the employer’s benefit.”
But Nix is a Southern woman of the “Steel Magnolia” variety. In other words, she’s not going down without a fight.
In September, she called out her insurance company’s tactics in a http://change.org/ campaign that has garnered more than 21,000 signatures. She has also filed complaints against her insurance company with the U.S. Department of Health and Human Services, U.S. Department of Labor, Illinois Department of Insurance, and Illinois attorney general.
Even so, Nix said, she feels defeated.
Not only is she still waiting for prior authorization to restart her immunoglobulin infusions, but her insurance company recently required Nix to secure preapproval for another treatment — routine numbing injections she has received for nearly 10 years to treat the nerve pain caused by trigeminal neuralgia.
“It is reprehensible what they’re doing. But they’re not only doing it to me,” said Nix, who is now reluctantly taking prescription opioids to ease her pain. “They’re doing it to other patients. And it’s got to stop.”
Do you have an experience with prior authorization you’d like to share? Click here to tell your story.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Dr. Stacy Sims’ Guide to Fitness and Nutrition after 40
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It’s worth noting that Dr. Sims has directed research programs at Stanford University focusing on female athlete health and performance, and she also has 94 peer-reviewed papers on the topic to her name.
Here’s what she has to say for those of us in the “women over 40” bracket:
What most people miss
Some notes on daily rhythm: Dr. Sims recommends to eat within an hour of waking, because cortisol spikes about 30 minutes afterwards, so, we can counter it with breakfast. She also advises we bookend our workouts with food, especially 30–40g of protein afterwards. Eat regularly through the day, have an adequate dinner, and avoid eating after dinner, to work with normal hormonal fluctuations.
You may be thinking “but I have long since menopaused; I do not have hormonal fluctuations”; in such a case, then do remember that “hormonal” doesn’t just mean sex hormones, it also means cortisol, serotonin, dopamine, leptin, ghrelin, insulin, and many others!
About heavy lifting after 40: declining estrogen changes muscle signalling, so women must rely more on central-nervous-system stimulation. Heavy loads create this stimulus, improving strength, power, lean mass, and nerve firing when hormonal signalling is reduced. So, lift heavy! But, also safely, please.
Some specific notes on high-intensity interval training (HIIT) of various kinds:
- SIT (sprint interval training): very short maximal bursts of 30 seconds or less at perceived exertion 9–10, followed by long recovery. effective for metabolic control and for signalling between skeletal muscle, the liver, and visceral fat. two intervals are usually the maximum for beginners if the effort is truly maximal.
- High-intensity training in general: true high intensity (e.g. 1–4 minute efforts at 80–90% of maximum heartrate with equal recovery) generates hormones that help lower cortisol afterwards. Moderate intensity does not create the same adaptive hormonal response.
On bone density, she recommends:
- Don’t bother with weighted vests for walking: wearing a weighted vest while walking can maintain existing bone but does not stimulate new growth. Basically, it doesn’t improve bone density because it lacks multi-directional stress, which is what’s needed per Wolff’s Law.
- Do use multi-directional jumps: for example, flat-footed pogo stick jumps or jumping rope, for about 10 minutes, three times per week. The “bone jump” app (developed from a 5-year study in 35–45-year-old women with low-normal bone density) provides structured jump progressions.
Two biggest things she wants us all to take into account, if we remember nothing else:
- Address sleep before fine-tuning training. Better sleep improves cravings, gut health, training response, and stress regulation.
- Ignore diet fads and instead focus on meal timing, consistent intake, and sufficient protein. Match your nutrition to your stress levels and training.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
Next Level – by Dr. Stacy Sims ← this is her book specifically about going from strength to strength through menopause and beyond 😎
Take care!
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The Couple’s Guide to Thriving with ADHD – by Melissa Orlov and Nancie Kohlenberger
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
ADHD (what a misleadingly-named condition) is most often undiagnosed in adults, especially older adults, and has far-reaching effects. This book explores those!
Oftentimes ADHD is not a deficit of attention, it’s just a lack of choice about where one’s attention goes. And the H? It’s mostly not what people think it is. The diagnostic criteria have moved far beyond the original name.
But in a marriage, ADHD symptoms such as wandering attention, forgetfulness, impulsiveness, and a focus on the “now” to the point of losing sight of the big picture (the forgotten past and the unplanned future), can cause conflict.
The authors write in a way that is intended for the ADHD and/or non-ADHD partner to read, and ideally, for both to read.
They shine light on why people with or without ADHD tend towards (or away from) certain behaviours, what miscommunications can arise, and how to smooth them over.
Best of all, an integrated plan for getting you both on the same page, so that you can tackle anything that arises, as the diverse team (with quite different individual strengths) that you are.
Bottom line: if you or a loved one has ADHD symptoms, this book can help you navigate and untangle what can otherwise sometimes get a little messy.
Click here to check out The Couple’s Guide to Thriving with ADHD, and learn how to do just that!
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Why Your Brain Blinds You For 2 Hours Every Day
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…and then covers its tracks so that you don’t notice:
Now you see it…
The world you experience is not an accurate representation of reality. Your brain actively constructs your perception, editing your memories as they happen and manipulating your sense of time. What you perceive as the present moment is actually a processed and reconstructed version of past events.
Nor is your vision anywhere near as detailed as it seems. Only a small central portion is in high resolution, while the rest is blurry. Your brain compensates for this by filling in the gaps with its best guess and/or what it believes is there from the last time you saw it. Your eyes constantly make rapid movements called saccades, and during these (i.e. when your eyes are moving), your vision momentarily shuts down—making you effectively blind for (in total, if we add them all up) about two hours every day (according to this video, anyway; our calculations find it to be more than that, but you get the idea). Your brain stitches together the visual input, creating a seamless experience that feels continuous (much like an animation reel composed of still images).
Why does it do this?
It’s because your senses operate at different speeds—light reaches your eyes in nanoseconds, sound in milliseconds, and touch signals in tens of milliseconds. However, your brain processes these inputs together, creating the illusion of a smooth and simultaneous experience. In reality, what you perceive as the present is actually a delayed and selectively edited version of the past.
Instead of showing you the world as it is, your brain predicts what will happen next. In high-speed situations, such as playing table tennis, if your brain relied on past sensory data, you wouldn’t react in time. Instead, it estimates an object’s future position and presents that prediction as your visual reality.
This also means that because your brain effectively sees things slightly sooner than you do, your brain has already prepared multiple possible responses and when an event occurs, it quickly selects the most likely course of action, deleting the alternatives before you are even aware of them. By the time you think you’ve made a decision, your body has already acted.
This goes for more than just the things we think of as requiring quick reactions!
Walking is a complex task that involves multiple time layers—your brain processes past feedback, assesses your current state, and predicts future movements. That’s why it was something that cyberneticists found difficult to recreate for a very long time. If something unexpected happens, like slipping cartoon-style on a banana peel, your body reacts before you consciously notice the danger. Your spinal cord and brainstem trigger emergency reflexes to stabilize you before your conscious mind even catches up.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
This Main Feature Should Take You Two Minutes (and 18 Seconds) To Read ← There’s a problem nobody wants to talk about when it comes to speed-reading; can you guess what it is based on what we just talked about above?
Take care!
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How Much Does Caffeine Affect Sleep, Really?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
We have written before about the health benefits (and risks) of coffee; for most people, the benefits far outweigh the risks, but individual cases may vary:
The Bitter Truth About Coffee (or is it?) ← this is a mythbusting edition
Speaking of bitterness; coffee has abundant polyphenols, which means an abundance of benefits that we discuss in the links above and below this line 😉
See also: Why Bitter Is Better: Enjoy Bitter Foods For Your Heart & Brain ← while it says foods in the title, this does cover coffee too.
For mythbusting on caffeine specifically, enjoy: Caffeine: Cognitive Enhancer Or Brain-Wrecker?
There are also gut health benefits from drinking coffee, and what’s good for our gut is invariably good for our heart and brain:
Coffee & Your Gut ← gut bacteria do not, by the way, have a preference about how you make your coffee or whether it is caffeinated or not
Aaaaaand, we recently shared new research on how coffee appears to be protective against frailty in older age. We say “appears to be”, because it was a longitudinal study and so technically we cannot say categorically that the link was causal, but the association is very strong, to the point that it’d take quite some explaining if it’s anything other than the coffee consumption that caused it.
You can read about that here: Coffee vs Frailty!
But what about sleep?
Common sense has of course long served to tell us: taking a stimulant before bed can disrupt your sleep. Shocking, breaking news!
Except, even we at 10almonds have never actually examined the science for this. After all, it seems so obvious; it’s like how one does not need a peer-reviewed study to conclude that water is wet.
However…
A study was conducted, and found that, upon investigating, caffeine indeed disrupts sleep, by an average of two hours per night!
Except…
That study, from 1974, had 6 participants (in fact the abstract says “subjects”, but that is how scientists referred to people in the 70s), and the methodology went:
❝…comparison being made with decaffeinated coffee and with no drink prior to sleep, using each condition five times in a balanced order on non-consecutive nights.
After caffeine the mean total sleep time decreased on average by 2 h, the mean sleep latency increased to 66 minutes. The number of awakenings increased and the mean total intervening wakefulness was more than doubled after caffeine.❞
Read in full: Effect of caffeine on sleep
Did you spot the problem? Aside from “n=6 is not a relevant sample size”… The methodology of using each condition five times in a balanced order on non-consecutive nights means that not only did they completely break from placebo (there is no mention of whether they even tried to blind or double-blind this) but also, think about this:
- It’s your first night at a sleep clinic. You take caffeine before bed, and you don’t sleep well; perhaps because of the caffeine or the strange environment.
- It’s the next night at a sleep clinic. Last night you slept 2 hours less than normal, so you absolutely crash out this time, and sleep extra to compensate.
- It’s the third night at a sleep clinic. Having overslept the previous morning, you’re not too tired tonight, and so you don’t sleep as much.
- The study only lasts 10 days so this pattern doesn’t get a long time to diminish.
See also: What’s Really Keeping You Awake? The Brain’s Role in Sleepless Nights
A more recent study was almost equally tiny (n=10) because it was just a pilot study, but used a better methodology with a double-blind control group design. For the first 7 days, all participants consumed caffeinated coffee. In the following 7 days, subjects consumed caffeinated or decaffeinated coffee according to their assigned group. This study found:
❝There were no significant differences (p > 0.05) among the data of the two groups identified. No significant changes (p > 0.05) were found in the sleep quality of either group during the study.
This study confirms that caffeine abstinence in the evening might not be helpful in sleep promotion. It highlights the need to implement evidence-based practice in health promotion.❞
Read in full: The effects of caffeine abstinence on sleep: A pilot study
What caffeine actually does, in the context of sleep
Now we’ll get into some meatier science, by which we mean that the same size is enough (n=40) to give us real statistical significance, and also it compared the effects on younger adults (20–27 years) and middle-aged adults (41–58 years), and monitored their brains with electroencephalography (EEG) during REM sleep and non-REM sleep.
They found:
- Caffeine reduced alpha and theta waves, linked to deep sleep.
- Caffeine increased beta waves, associated with wakefulness* and mental activity.
*Note: it increased these beta waves during sleep. It did not affect sleep quantity, it merely changed its quality. And, not necessarily badly, because that’s needed too (such as for memory consolidation and other mental faculties), but meaningfully.
They also found that these effects were more pronounced in young adults (ages 20–27) than in middle-aged participants (41–58).
You can read the paper in full here: Caffeine induces age-dependent increases in brain complexity and criticality during sleep
And you can learn about brain waves during sleep, here: Alpha, beta, theta: what are brain states and brain waves? And can we control them?
And for getting into hacking some of these: Non-Sleep Deep Rest: A Neurobiologist’s Take ← How to get many benefits of sleep stages, while awake!
We’re running out of space today, but before we go, we’ll mention this larger (n=99) longer (12 months) study into matcha green tea instead. Of those 99 participants, the study included 64 with subjective cognitive decline and 35 with mild cognitive impairment; these were randomized, with 49 receiving 2 g of matcha and 50 receiving a placebo daily, and to quote from the conclusions in the paper:
❝Despite the presence of caffeine, which disrupts sleep, matcha demonstrated a sleep-enhancing effect. This beneficial effect is attributed to theanine, a constituent of matcha.
The present study suggests regular consumption of matcha could improve emotional perception and sleep quality in older adults with mild cognitive decline❞
Don’t love coffee?
Two excellent alternatives are green tea (and/or green tea extract), and green coffee extract. You can read about them both here:
Enjoy!
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How Too Much Salt May Lead To Organ Failure
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Salt’s Health Risks… More Than Just Heart Disease!
It’s been well-established for a long time that too much salt is bad for cardiovascular health. It can lead to high blood pressure, which in turn can lead to many problems, including heart attacks.
A team of researchers has found that in addition to this, it may be damaging your organs themselves.
This is because high salt levels peel away the surfaces of blood vessels. How does this harm your organs? Because it’s through those walls that nutrients are selectively passed to where they need to be—mostly your organs. So, too much salt can indirectly starve your organs of the nutrients they need to survive. And you absolutely do not want your organs to fail!
❝We’ve identified new biomarkers for diagnosing blood vessel damage, identifying patients at risk of heart attack and stroke, and developing new drug targets for therapy for a range of blood vessel diseases, including heart, kidney and lung diseases as well as dementia❞
~ Newman Sze, Canada Research Chair in Mechanisms of Health and Disease, and lead researcher on this study.
See the evidence for yourself: Endothelial Damage Arising From High Salt Hypertension Is Elucidated by Vascular Bed Systematic Profiling
Diets high in salt are a huge problem in Canada, North America as a whole, and around the world. According to a World Health Organization (WHO) report released March 9, Canadians consume 9.1 grams of salt per day.
Read: WHO global report on sodium intake reduction
You may be wondering: who is eating over 9g of salt per day?
And the answer is: mostly, people who don’t notice how much salt is already in processed foods… don’t see it, and don’t think about it.
Meanwhile, the WHO recommends the average person to consume no more than five grams, or one teaspoon, of salt per day.
Read more: Massive efforts needed to reduce salt intake and protect lives
The American Heart Association, tasked with improving public health with respect to the #1 killer of Americans (it’s also the #1 killer worldwide—but that’s not the AHA’s problem), goes further! It recommends no more than 2.3g per day, and ideally, no more than 1.5g per day.
Some handy rules-of-thumb
Here are sodium-related terms you may see on food packages:
- Salt/Sodium-Free = Less than 5mg of sodium per serving
- Very Low Sodium = 35mg or less per serving
- Low Sodium = 140mg or less per serving
- Reduced Sodium = At least 25% less sodium per serving than the usual sodium level
- Light in Sodium or Lightly Salted = At least 50% less sodium than the regular product
Confused by milligrams? Instead of remembering how many places to move the decimal point (and potentially getting an “out by an order of magnitude error—we’ve all been there!), think of the 1.5g total allowance as being 1500mg.
See also: How much sodium should I eat per day? ← from the American Heart Association
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Hack Your Hunger
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
When it comes to dealing with hunger, a common-sense way of dealing with it is “eat something”. However, many people find that they then eat the wrong things, in the wrong quantities, and end up in a cycle of overeating and being hungry.
If this gets to the extreme, it can turn into a full-blown eating disorder:
Eating Disorders: More Varied (And Prevalent) Than People Think
…and even in more moderate presentations, the cycle of hunger and overeating is not great for the health. So, how to avoid that?
Listen to your body (but: actually listen)
Your body says: we’re running a little low on glycogen reserves so our energy’s going to start suffering in a few hours if we don’t eat some fruit, kill something and eat its fatty organs, or perhaps find some oily nuts.
You hear: eat something bright and sugary, shout at the dog, eat some fried food, got it!
Your body says: our water balance is a little off, we could do with some sodium, potassium, and perhaps some phosphorus to correct it.
You hear: eat something salty, got it, potato chips coming right up!
…and so on. Now, we know 10almonds readers are quite a health-conscious readership, so perhaps your responses are not quite like that. But the take-away point is still important: we need to listen to the whole message, and give the body what it actually needs, not what will just shut the message off the most quickly.
Here’s how: Intuitive Eating Might Not Be What You Think
Bonus: Interoception: Improving Our Awareness Of Body Cues
About those cravings…
As illustrated a little above, a lot of cravings might not be what they first appear, and in evolutionary terms, our body is centuries behind industrialization, in terms of adaptations, which means that even if we try to take the above into account, our responses can sometimes be inappropriate in the age of supermarkets.
See also: The Science of Hunger, And How To Sate Cravings
Natural appetite suppressants
Eating more is not always the answer, not even if it’s more healthy food. And hunger pangs can be especially inconvenient if, for example, we are fasting at present, which is by the way a very healthful thing for most people:
Learn more: Intermittent Fasting: What’s the truth?
One way to suppress hunger is simply to trigger the stomach into sending “full” signals, which involves filling it. Since you do not want to overeat, the trick here is imply to use high-volume food.
Consider for example: 30 grapes and 30 raisins have approximately the same calorie count (what with raisins being dried grapes, and the calories didn’t evaporate), but the bowl of fresh fruit is going to physically fill your stomach a lot more quickly than the tiny amount of dried fruit.
More on this: Some Surprising Truths About Hunger And Satiety
Protein is of course also an appetite suppressant, but it takes about 20 minutes for the signal to kick in. So a “hack” here is to snack on something proteinous at least 15 minutes before your main meal (for example, a portion of nuts while cooking, unless you’re allergic, or some dried fish unless you’re vegetarian/vegan; you get it, pick something high in protein and good for snacking, and have a small portion before your main meal).
Nor is protein the only option!
See also: 3 Natural Appetite Suppressants Better Than Ozempic
Scale it down
Related to the above, there is a feedback loop that occurs here. The more you eat, the more your stomach slowly grows to accommodate it; the less you eat, the more your stomach slowly shrinks because the body tries hard to be an efficient organism, and will not maintain something that isn’t being used.
So, there’s a bit of a catch-22; sate your hunger by filling your stomach with high volume foods, but filling it will cause it to grow?
The trick is: do the “eat until 80% full” thing. That’s full enough that you have had a nice meal and are not suffering, without stretching the stomach.
Enjoy your food
Seriously! Actually enjoy it. Which means paying full attention to it. Eating can and should be a wonderful experience, so it’s best savored rather than inhaling a bowl of something in 30 seconds.
Have you seen those dog bowls that have obstructions to slow down how quickly a dog eats? We can leverage that kind of trick too! While you might not want to eat from a dog bowl, how about having a little bowl of pistachio nuts rather than ready-to-eat peanuts? Or any shelled nuts that we must shell as we go. If you’re allergic to nuts, there are plenty of other foods with a high work-to-food ratio. Take some time and enjoy that pomegranate, for instance!
Not that we necessarily have to make things difficult for ourselves either; we can just take appropriate care to ensure a good dining experience. Life is for living, so why not enjoy it?
See also: Mindful Eating: How To Get More Out Of What’s On Your Plate
Enjoy!
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