So let me start off by saying that my health insurance carrier has actually been quite supportive through the cancer experience thus far. Until the last few days, I’ve experience zero chain yanking and a great deal of positive, useful support from them, largely in the person of my cancer case manager.
However, last week I got a coverage letter telling me my oncologist is out of network for my PPO plan. This triggers an entirely separate deductible process, wherein I have to pay the first $2,500 for out of network coverage, after which I then pay 30% of charges instead of my usual flat co-pay. That would mean another $2-3,000 out of my pocket this fall, given where everything is going.
Finally got through to my case manager yesterday to discuss this. She verified they had no listing for my oncologist, and strongly advised me to find another oncologist. Long discussion about networks and coverage. My case manager was being as helpful as she could be within insurance company rules, but from my point of view, this whole thing is madness. They’re already preparing to spend about $250,000 treating me, and they’re barfing on $2,500 or so worth of doctor bills. Starting with the $279 sitting on my desk right now.
I called the clinic at my primary hospital after I got off the phone with my case manager, to explore it from their end. For example, could they rebill, etc. The medical administrator there was quite surprised to hear that my oncologist was out of network. According to her, all the doctors at the clinic are in network with my carrier under a master contract. Long discussion about networks and coverage. Much frustration on my part.
This gal is a Hero of the Revolution, so far as I am concerned, because she took my information and promised to call the health insurance company from the provider side and work through this. Still, what a mess.
Health insurance reform isn’t just about access, it’s about sanity. Or at least it better damned well be. With the exception of almost being killed by ER triage last year (literally), my experiences with the healthcare delivery system have ranged from good to admirable. My experiences with the healthcare finance system have ranged from adequate to surreal.
Also, in discussions with the case manager, we began reviewing the collateral medications associated with chemotherapy. I’m going to be a walking pharmacy before this is all over with. Anti-nausea, anti-inflammatory, anti-anxiety, et cetera, et cetera, ad nauseum. My biggest concern about the chemo trip is preserving mental acuity, so I’m very dubious about steroidal anti-nausea drugs, as well as anything psychoactive such as anti-anxiety drugs.
Upcoming I have another CT scan on 7/20. That’s when we discover whether or not my lungs are a pair of tumor sacks. We’ll also validate some of the other data and assumptions about liver and lymph. Unless something unexpected arises from that scan (or unless I have to switch oncologists for insurance reasons), I’ll have my chemo prescribing appointment on 7/27. With luck, I can get the Harkonnen heart plug installed quickly enough to go to Worldcon while I’m recovering from that surgery, and begin the chemo when I get back.
I’ve decided to leave further documentation of my emotional freakouts for another day. Plenty of more-or-less objective detail here now. More as it develops.