Monday, July 27, 2009

Because, apparently, fighting cancer isn't stress enough...

This morning, day 14 of chemo, one of my to-do's was to address a growing stack of medical bills and contradictory insurance explanation of benefit (EOB) statements. I receive the bills and set them aside until I receive the corresponding EOB from the insurance company to find out what my portion of the bill is. If there is confusion, I call the insurance company. Well, every bill in the stack created confusion because if there was a corresponding EOB they didn't match - either physician name, amount, etc. I knew it would be a challenging task. I called the insurance company first to figure out which of the bills I needed to pay. Verdict...all of them. ;/ I asked the representative why since the EOBs indicated my portion owed was $0 and that my annual deductible and out of pocket maximum was met. She put me on hold and then returned and explained that my out of pocket maximum was not met until 6/24 (by the way, my new year starts 7/1 so that didn't do me much good, did it!? LOL). She had no answer as to why my EOBs dated earlier than that stated that it was met already. ugh. While I had her on the phone I asked her how much of the current year deductible and out of pocket limit had been satisfied (the year beginning 7/1) and she said that the deductible was met already (and that I have another $1500 to go before I meet the out of pocket max)! I was a bit surprised since I have not received a single EOB or physician bill for anything dated after 7/1 yet. I guess the port placement surgery and the first chemo treatment did the trick...but that means that after paying about $1000 of medical bills this morning (my portion of the surgery and pathology in June) did not even include the $500 worth that I haven't been billed for yet for medical treatment received in July. At this rate, I'll meet my $2,000 annual out of pocket maximum (minus copays since I'll have to keep paying those) by September based on planned treatments. Think that's bad enough? Apparently, the insurance company doesn't. I just received a EOB today indicating that I may be on the hook for $3,851 for the cost of my mammogram! I called them to ask what that was all about and I was told: "it's under review for medical necessity". Shall I repeat that? Yeah, I didn't think I needed to. I asked the representative if this was some kind of sick joke and she didn't appreciate that very much and tried to explain to me that because I'm under the age of 39, that makes a diagnostic mammogram an unusual claim. I couldn't help but laugh when I heard that. I reminded her that they already had approved and paid for the double mastectomy and the first round of chemotherapy treatment and asked her if she thought that the mammogram was medically necessary. She didn't have much of an answer for that. Then I asked her why they sent me an EOB stating that the $3,851 was "patient responsibility" if they are supposedly still reviewing and haven't yet decided whether they'll be paying for it. She didn't have an answer for that either. I reminded her that before I went in for the diagnostic mammogram I called and asked if it would be covered and I was told: "if a doctor deems it medically necessary" and I followed it by stating that my doctor ordered it based on my feeling a lump in a self exam and I was told "that sounds medically necessary to me." I asked to speak with someone involved in the decision and was told that claim examiners "don't take calls from customers." Isn't that unbelievable!? The representative then proceeded to try to convince me that it's too early to be upset about this (she actually said that! and I responded something like "if you were me, staring at a $4k bill you probably wouldn't think so") - that they're awaiting supporting medical records from the provider. Again, I had to laugh and then asked them what kind of record might they be looking for - something that says I called my doc and said I felt a lump and the doc said to go get a mammogram? I mean, come on - there's a doctor's order for a diagnostic mammogram and sonogram in the file that was sent to them - what more could they possibly want beyond that and the fact that they KNOW I had breast cancer that required surgery, chemo and additional treatments to come!? Do they actually think I might go get a mammogram, sonogram and biopsy for fun? All of this got me thinking about how awful it would be to not have health insurance at all. I mean, sure it's annoying and still very expensive to be sick WITH insurance. However, for those that don't have insurance, an illness would be financially devastating. I have friends who can't afford health insurance because their employers don't offer it and individual insurance is too expensive for them or because they have a history of health issues that has led insurance companies to deny them policies. It breaks my heart knowing that an accident or illness could ruin them financially because of the way our healthcare system works in this country. The other day we were at the pool with Cooper and we met a neighbor who moved here from Italy a couple years ago. He told us about how his father had two transplants and didn't have to wait nor pay a dime for it, and how his daughter was born in Italy and they paid absolutely nothing for her maternity care and delivery and the mother was on paid leave for nearly a year! My mom, who is a conservative, looked at me and said "if that is what socialized healthcare is then I'm all for it." - I nearly choked. LOL I'm very aware that I am among the lucky and privileged because I work for an outstanding employer that provides excellent benefit options and for that I'm incredibly grateful. I'm more aware now than ever before that most Americans are not as lucky as me in this regard and while I've always believed we need healthcare reform in this country, I believe it now more than ever before. Routine and diagnostic mammograms, for example, shouldn't require a fight with an insurance company when there is a legitimate need for the test. Shortly after my diagnosis of breast cancer, my husband said to me "I see you testifying before congress regarding mammogram coverage/availability for women under 40." and I just laughed and thought about how all my energy needs to be focused on fighting this cancer. But he is right - I can't sit back and watch this happen, knowing it's happening to women (and men) every day. Something needs to be done about it. So, in my spare time, I'll be working on that. ;) Anywho...what's in store for the rest of this week? I start physical therapy tomorrow. Shave my head Wednesday night and donate my hair to Locks of Love. Support group on Thursday. Booby expansion appointment on Friday. I need to squeeze in writing a letter to the head administrator of Northridge Hospital (about that horrific experience I had with the first port placement attempt), and call the breast imaging center to make sure they sent the "records" to the insurance company...and the list goes on (but I won't bore you).

10 comments:

  1. That is crazy! I I know lots of people stay in th eteaching field just for the health insurance! Sounds like you will make a great congressional speaker! You can kick cancer's ass and your insurance company's ass too!

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  2. The insurance stuff is crazy. Let me know how/if I can help. xoxo

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  3. I'm sorry you were given a hard time. I am grateful that our insurance company picked up all of our cancer care bills however if they did not our church was ready to step in and help out with medical expenses.

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  4. Girl, I occasionally get paralyzed with fear that MORE medical bills will come up and I won't have back-up to prove that it was taken care of. I've had UCLA bill me the first time for things that went on 18 months prior -- and not even blink when I called this to their attention. ARGH. I feel for you. Just keep everything in one place :-)

    If you need a pic of me with the 4-drawer filing cabinet housing it all for the Congressional hearing, let me know soon, because I may need to burn it all in a banishing ritual or something!

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  5. Seriously, that is way too much stress for someone fighting cancer. May I suggest writing down name/time/jist of conversation with everyone you talked to? Also - if they have three way calling, get the hospital billing and insurance all on the phone at the same time.

    I'm thinking of ya!

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  6. This post sounds like one of those emails that needs to go 'round the world (or at least the US). Seriously, you need to copy this post and email it to everyone in Congress because it's THAT good.

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  7. Wow, I don't even know what to say. And I thought I had heard my share of excuses/explanations from insurance companies. But that takes the cake. If I were the lady you talked to today, I would feel like a COMPLETE idiot! I really hope they get that all figured out. And I think the claims people owe you a persoanl apology for what they are putting you through. *hugs*

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  8. Julie - I can't even believe that the insurance company is considering making you pay for your mammogram, especially at this point in the game. I am also suprised, I had a mammogram done about 3 years ago for a lump that I found in my breast (ended up not being cancerious) and it was covered by my insurance. I was under 25... I certainly don't think it's an uncommon claim to make for a woman under 40 - that's just their way of trying to get out of it. Jerkfaces!

    As far as the medical goes - I can appreciate your concern for those of us who do not have insurance. Up until June 30th, I was fully insured... now I am not. Infact, the only one that is insured is Emri and she's on DSHS - it's truely a scary thought to not have those benefits and I will say that I never took them for granted. I will also say that I miss that safeguard. If something were to happen to either Shawnn or I, it would surely put us under. Heathcare is important, and I find myself picking and choosing which ailments to pay more attention to. I'm all for reformed heathcare, even if it were to somewhat inconvenience me, I'd rather be able to see the doc than not.

    And by the way, you're so amazing - your courage and determination is an inspiration to me every day. I have been telling everyone I know about your story - know that you're in a lot of people's thoughts and prayers!

    xoxo
    Danielle

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  9. Incredible. What would be more incredible is if you took all of this paper and marched into Marge M and/or Rodger H's office ... and said, "Here, you deal with it!" The people responsible for our insurance plans should feel a bit of your pain.

    Is recording your conversations with these jackasses an option? It would make for some GREAT fodder ... or something.

    I would LOVE to see you go before Clowngress. And I would go be there to support you in person. I can't think of a better reason to go to DC. Sadly, I have no faith in anyone in Washington. That is, until you get there. My money & faith is on you!

    Big hug Julie! I will help you in any way I can.

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  10. I'm sorry you have to deal with all of this on top of the trials you are already facing. I know how you feel about insurance, up until May 22 we didn't have insurance because we are in the group you mentioned (employer doesn't offer it and we couldn't afford it..still can't). Konner was on medicaid, but when our income went above the max (by $100/month) we had to get our own. Now we pay a ton for it and I just found out that they will not cover this pregnancy because we are on an individual plan and that the lady that told me it would be approved thought I was on a group plan. Stupid...same plan, just individual vs. group and now we have to pay for everything. I've always been for socialized medicine, but its nice to see someone that has insurance feel the same way. I'm usually told its because I'm a "have not" in this area.
    I digress...anyway, you have my support in your current daily battles and in your future battles with Congress. P&PT Always!

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