September 17, 2009

• Holy Cow!

  Posted by Stephanie 9:50pm CST from the apartment Houston, TX

  Boy, has it been a roller-coaster couple of days with this insurance situation! Here's what's happened since yesterday's post:

  While waiting for a callback from Mara, I called the sarcoma business center (yes, every treatment center at MD Anderson has their own business center to handle authorization and other issues) to get verification of the insurance approval for the GemTax treatment there in Houston. Turns out the phone was answered by the very person who called to do my verification. She pulled up my account information and told me she had the name, date and authorization reference number for the phone conversation she had with someone at my health insurance company. I asked what she was told when she called, and she said that the man she talked to told her there was "No pre-certification required" for that treatment. They would just send the insurance company the claims, and because they didn't consider it strange or expensive enough to need special pre-certification, things should get paid at normal network percentages. I thanked her for the information and hung up. Hmmm.....strange. Why would one place be told there was no need to pre-certify and another place be told that wasn't an approved treatment for my diagnosis. I called back to the insurance authorization person at Dr. Romer's office. I got her voicemail and left the message with that information so that she'd have something to go back at the insurance company with.

  I then called my case manager at the insurance company. I've been really fortunate that from the beginning of my treatment almost four years ago, I've had a case manager that entire time. That's not common or necessary for most people, but when you're dealing with such a high-dollar catastrophic case such as mine, a case manager is almost always assigned to assure things run smoothly. My case manager is actually part of a cancer-care center at the insurance company, and is a nurse with oncology experience, which is extremely helpful. When I spoke to her and explained the situation, she too, thought that things didn't quite add up. For MD Anderson and Romer's office to be told two completely different things just didn't make sense. The bottom line is that if it was approved at MD Anderson, and it's the same treatment, then this is just a continuation of my care, and it shouldn't matter where the treatment takes place. Sounds to me like somebody somewhere along the line screwed up! Anyway, she assured me she would look into this, make some calls, and see if she could find out what was going on.

  That was all I knew at the end of the day yesterday. It still wasn't looking good, and I had pretty much resigned myself to being down here to continue treatment. I didn't hear anything today until almost one o'clock, when I got a call from the case manager at the insurance company. She said she had spoken to some people, made some extra notes in my file, and that I was now approved, covered and pre-certified for treatment in Ohio. Yippee!! She's magic, or a miracle worker, or something like that. She said all that Romer's office needed to do was call back to the benefits department for verification, and if they were told anything other than what she just said, I was to call her back. I immediately called Romer's office and told the insurance authorization person this news. She said she too had gotten a message from my case manager, but that the insurance company was still telling her this wouldn't be covered, so until she got some sort of official written verification, she considered it a no-go. Ugh. I was promised a call once things were squared away. So, I waited. Mara finally returned my call from yesterday, and we got chemo set up in Houston for Monday, just in case. And, I waited some more. I couldn't let the apartment people know we were planning to leave this weekend, because things still weren't certain. Still waited. Finally, just before the end of the business day, I heard back from the insurance authorization contact at Dr. Romer's office. The first words out of her mouth when I answered the phone were, "Holy Cow!". Huh? She said she'd heard back from my case manager and sure enough, things had gotten worked out (didn't I already tell her that?), and she was being faxed verification. Then, she said it again. "Holy Cow!". It was obvious she was impressed things had gotten worked out so quickly (or at all). I don't think she expected turn-around like that, since most of her dealings with insurance companies are probably long, drawn out, painful processes that aren't expedited by the presence of a competent case manager. I can't believe she was that blown away, but it sure gave me a good chuckle. She also added that she's still being told it won't be covered when she calls to verify benefits, but since we have the assurance of my case manager, she said that's what we'll go with. Works for me.

  Two days of things hanging in the air, then suddenly everything's happening in a blur--trying to get the apartment thoroughly cleaned, organizing medical supplies, packing, notifying the church that we're vacating the apartment permanently (this church group collects payment in-person weekly, which we wouldn't be here for, and if you don't have regular hospital apartments, they make you give the place up--that's different than churches we've dealt with in the past, who don't care if you're gone a few weeks as long as you're still paying), etc. Yesterday we were going to be stuck here for the forseeable future, and now we're leaving tomorrow afternoon. At least, that's the plan, as long as everything gets done. That way, we can do the short leg of the drive tomorrow, then the long day on Saturday. My sister is going to be in Ohio from North Carolina to see some friends of hers, so we wanted to get home in time to visit with her for at least a short time before she left to drive back Sunday.

  I'm totally drained after the stress of the last few days. Still feeling some apprehension about getting this done at home, away from the security blanket that MD Anderson has become. More on that later. But, it should be okay, and I'm certainly excited to be home long-term. Right now, it's shower and dressing change time, then more cleaning and sleepy time. Have a good night!

  --Steph

  • 11:51 pm
  • 2 Comments