Tuesday, October 26, 2010

Health Update

As some of you who read this blog knows, I have been having some new health issues these past few months. I haven't really mentioned them on here because I just hoped they would go away. Plus, let's face it, I seem to always have something to complain about and I didn't want this blog to be all about what is wrong with me today. Well, this problem is not going to go away without another trip to the hospital.

Long long story short - I started taking tamoxifen two years ago right after I finished chemo. I'll take it for three more years. It was prescribed for me since my cancer was 100% estrogen positive and tamoxifen blocks the effects of estrogen. So, I take it to decrease my chances of having cancer return. Now, like all cancer "treatments" that the medical industry recommends, there are all sorts of nasty side effects of taking tamoxifen - more than I want to list here. All of the literature says that the benefits of tamoxifen in treating breast cancer far outweigh the ricks of serious side effects. Two of those side effects though are endometrial cancer and/or ovarian cysts. Especially in women who were pre-menopausal when they were diagnosed with cancer.

Starting in August I started showing the symptoms of potentially having one or both of them. I got into a doctor pretty quickly. She right away did a biopsy that day and sent me for an ultrasound. The biopsy results came back inconclusive and the ultrasound showed something wrong with my ovary (I've only had one since the other was removed in my 20s) plus an enlarged uterus. She then signed me up for out patient surgery so she could go in and get a good cell sample for another biopsy and so she could take a look at the ovary and the uterus. This was a couple of weeks ago. She said that if I did not hear from her by the next Wednesday, the biopsy results came back OK.

I have a side not here - I have obviously not had good news from biopsies in the past. Would it have been so hard to give me a call either way just to let me know? It would have saved a whole bunch of us a lot of worry.

We met with her two weeks later and as soon as she walked into the room she told us that there was no sign of cancer! Great news! On the other hand, she said, my ovary is pretty much rotten and needs to come out pretty quickly. And since I then won't have any ovaries, there won't be any reason to keep the uterus. Plus if I don't have the uterus removed now I will continue to have the issues I am having, they will continue to get worse, and it will lead to more problems probably sooner rather than later. So, she says I need to have a hysterectomy to take it all out. (I asked her for any cons to have my uterus removed and she could not give me any other than not being able to have kids which I won't be able to have anyway. I will be doing some research to see if there are indeed no other cons.)

It means I may need up to six weeks off work to recover. I asked her when it needed to be done and she said she would want the ovary removed by the end of the year. I asked if we could hold off until mid-January because now is a super busy time at work and she agreed to that time frame if I have another ultrasound before then and now. As long as the ovary has not gotten worse, we can wait; if it has gotten worse, we do the surgery early December.

So, those are my exciting upcoming plans - an ultrasound the week before Thanksgiving and a hysterectomy in January.

I am so tired of surgeries and medical bills and missing work and worrying, that I am really bummed about the whole thing, but by golly the news could have been much worse. I truly believe I just need to get through this last dip and it will all be uphill from here. It has to be, right?!

Wednesday, October 20, 2010

Susan G. Komen 3 Day Walk Fundraising

Team Grand Canyon hit the $17,000 fundraising mark today! All seven of us will have raised the $2,300 minimum amount to be allowed to participate in the walk which is only 3 and a half weeks away.

It is not too late to donate! :)

Linda's donation page

I have been training as much as I can with a busy work schedule and some more health issues. I hope to get some good miles in this weekend.

Some fun news - I have been nominated and chosen to be a member of the Survivor's Circle this year at the opening and closing ceremonies. I am will be carrying the "commitment" flag and am very honored to be chosen.

Tuesday, October 12, 2010

Insurance Fun and Games

I know it is a blessing that I have a good health insurance plan. I did not have to make any health care decisions based on financial worries. I can't even imagine the struggle of going through a cancer fight with no or inadequate insurance. So, while I am going to complain about my health insurance company, I know there are others out there wishing they had my insurance even with the headache of dealing with them.

So, back in July I was having quite a bit of back pain. One day while I was massaging it, I felt a lump just to the right of my back bone. The last time I found a lump, it did not go well. I wrote about the ensuing PET scan a few posts back. Fortunately, the results came back clean.

I received a claim report from my insurance company about a month later. It said that my PET scan was not covered by my insurance and that I was responsible for the entire $6,700. My breath caught in my throat but it had to be a mistake - right!? I pulled up my coverage plan online and right there it said that PET scans are covered at 90% after my deductible. I also noted that the coverage said that if I used a preferred provider, it was the provider's responsibility to make sure that the scan was pre-authorized. Excellent news.

I called my insurance company first. I talked to a nice lady named Carolyn. She looked up my claim and agreed that it was indeed covered under my insurance plan but that the radiology center did not have it pre-authorized. She said that they could at this point try to get it post-authorized. OK - strange that they did not get a pre-authorization but now I have a starting point to get this fixed.

I called the billing department of the radiology center. No, I was told they would not be the one's to have it pre-authorized, it would have been my doctor who would done it before even having the PET scan scheduled.

I called the financial lady at my oncologist's office. What?! They would never be the one's to get the pre-authorization, they would send my medical records over to the radiology center and it would be the radiology center who would call the insurance company. Great. The financial lady did give me a phone number for the supervisor of the department in radiology that gets pre-approvals.

I called the supervisor of the department in radiology that gets pre-approvals for PET scans. The supervisor was busy but I did talk to a helpful lady who was able to pull up my account. Here it is - the billing department should have been able to see this also - but we did call for a pre-approval and "Jeff" at your insurance company said it did not have to be pre-approved. The helpful lady said that she would call again and have it post-approved. She said that if I received a bill from them for the entire amount, I should call the radiology billing department again and they would put the bill on hold until this was all figured out.

Great - this seems to be taken care of. Two weeks later I received a bill from radiology for the entire amount.

I called the radiology billing department to put the bill on hold. Another nice lady looked up my account. They had tried to have the PET scan post-approved but my insurance company told them that the procedure was not covered under my plan. She could give me an extra two days to pay the bill but I need to start making payments in two weeks. And they will only give me 6 months to pay the bill so my first payment needs to be over $1,000. Wonderful.

I called my insurance company - and got Carolyn again. Her lucky day. She looked up my account. Yes, she can see where "J" (for "Jeff'?) told Vicki at the radiology department that the PET scan did NOT need to be pre-authorized. However, it did need to be pre-authorized. She did not at all see my frustration of the insurance company saying BEFORE the PET scan that it did not need to be pre-authorized and now saying AFTER the PET scan that it did need to be pre-authorized. Are you kidding me? But it gets better. So, she says that radiology will need to have it post-authorized. I understand, I say, they did try to have it post-authorized but when radiology called the insurance company, they were told that the procedure was not covered under my plan and the insurance company would not let them post-authorize it. Yes, Carolyn says, she can see where radiology called and was told that the procedure was not covered. The person at the insurance company, however, was "looking at a screen in the new system where it looks like PET scans are not covered but if they look at a screen in the old system it shows that it is covered" She suggested I call radiology back and that the person who calls this time to have it post-authorized should be persistent and ask for a supervisor. While Carolyn was always very friendly, she never did acknowledge that what she was telling me was just beyond frustrating. I thought about it later and working for this insurance company, she must spend 8 hours a day dealing with their ineptitude or at least their attempts to avoid paying for insurance claims. I am sure she has seen it all and worse.

So, let's recap. Radiology calls to have PET scan pre-approved. Insurance company says it does not need to be pre-approved. Linda has PET scan. PET scan claim is denied. Insurance company says PET scan needed to be pre-approved and now needs to be post-approved. Radiology calls to have PET scan post-approved. Insurance company says PET scan is not covered and won't let radiology post-approve the PET scan.

I call the supervisor of the department in radiology that gets procedures pre-approved. She pulls up my file. She points out that they have tried twice now to have my PET scan authorized and the insurance company refuses to let them. "I don't know what we can do for you at this point." Well, I hate to say it but I got a bit teary eyed as I begged her to help me. I pointed out that I had no idea that to do at this point either. She took pity on me and said she would give a call about my dilemma to a supervisor in the billing department that she knew. She said that since it was later in the day in the mid-west but she would let me know if she heard anything.

At this point I decided to get our company benefits coordinator involved also. I wrote all of this up and sent her copies of my claim denial and radiology invoice. She talked to someone with the insurance company who asked her to send over my medical records. Hey, how about that, someone at the HEALTH insurance company agreeing to finally see my HEALTH records!

I called the supervisor of the department in radiology that gets procedures pre-approved. She had not heard anything from her billing department so was very happy to send over my medical records. And get me out of her hair.

I called the billing department of radiology and explained where we are on everything and was told that they would delay the date of my first payment by a month!

It took two weeks but I did get word from our benefits coordinator that the insurance company has agreed that it was a medically needed a procedure and that it will be covered! WooHoo. But they are waiting for an out of state adjuster to take a look at it before they send any payments out. What?!?! I am trying to be an optimist but it has been a week and everything still says that the claim is still rejected.

So, stay tuned. I might be making some more phone calls. I hope I get Carolyn again. I bet she remembers me this time.

This is just the most recent egregious example I have of my insurance wars. At least now I am feeling well and just have the one problem. Back when I was in treatment, I was receiving up to twenty bills a week. It was impossible to keep track of everything when I was so sick. I figure I paid over $1,000 more than I should have but I just didn't have the strength/energy/mental accumen to play these games.

Shame on insurance companies. To take advantage of people when they are at their lowest like that is just inexcusable.