Archives for posts with tag: health insurance

ThoughtBubblehttp://roadkillgoldfish.com/friends-cancer-want-know/

Money2I was diagnosed with breast cancer in early October 2013 and had 11 business days to prepare for double mastectomy. Virtually every other day I was heading somewhere for a test or to fill out paperwork. Not only did I have to take care of so much administrative stuff before surgery, I also had to get my house ready, and I had to make preparations at my job. Needless to say, this was extremely difficult because of the tight time constraints coupled with a diagnosis that scared the begeezus out of me.

One of the many tests my surgeon scheduled for me in the 11 days prior to surgery was a PET scan and an MRI. Perhaps now is a good time to say I am fully insured having a PPO with a major provider via my employer. After surgery on Oct 29 I had to go back for second surgery 3 weeks later for more lymph node removal. Then chemo began Friday the 13th ( I kid you not) of December. 4 months of chemo followed by 33 radiation treatments and I am now trying to return to normal.

About a month after my initial surgery, I received notice from my insurer that my claim for the MRI/PET was being rejected and I should expect to receive a bill from the facility that performed those two diagnostic tests. My insurer let me know I was responsible for payment in full. Shortly after that I got a bill for roughly $8500.00.

So began a frightening journey into insurance hell. I am a smart person but I know virtually nothing about how to fight an insurance company. I felt like a blind person in a cave swinging at lumps of coal. My repeated attempts to resolve were futile. I shared my frustrations with our HR rep at work and he reminded me that our benefits plan included the service of Health Advocate. So I reached out that day and it was one of the best decisions in my life.

First, lucky for me that our HR rep was informed because I certainly was not. Second, I am just so grateful for such a service and happy to know it is another one of my employer-provided benefits.

Working with the Health Advocate rep was simple, timely and straightforward. Communication was always on time and easily understood. I would not have known all the required steps nor the timing of those steps in order to wage a good fight regarding this $8500.00 charge. But my HA rep knew and finally managed to win on our final appeal. I ended up paying $114.00 instead of $8500.00 and this appeal process took about 4+/- months. I would have failed without the assistance of Health Advocate.

I have since recommended the HA services to anyone who will listen. I encourage anyone facing health care issues to investigate HA and utilize them if necessary. I was trying to fight the rejected claim with emotional responses. The Health Advocate is schooled in responding with medical and processional reasoning which certainly has a greater chance for success.

Even fully insured, this cancer battle has been a huge expense that I never saw coming. It would have been so much worse, had I been responsible for that $8500.00 bill.

Thank you new-best-friend Health Advocate! I expect to stay in touch for many years to come.

That’s my story. I hope this is helpful.

  • Tuesday Oct015 update:. I am already sick of pink and I was only diagnosed a few days ago.  Maybe someday soon I will embrace it but for now it feels more like a scarlet letter than a sorority solidarity color.  Visited the oncologist today just for a consult.  She inspired great confidence and comfort and that is a wonderful feeling.  Among other things I asked her if I had to have reconstruction and her answer was a fabulous gift.  Essentially she told me I didn’t have to do anything that I didn’t want to do – even if that meant going breastless.  So maybe I just opt out of reconstruction.  I am 56, have no one that sees me naked (except physician) and I like to play golf.  As I see it, getting rid of lucy and rita might improve my golf swing.  So I will ponder that for a few days.  

I log onto my insurance provider web site each day and watch as claims roll in and get tallied.  And while this is an exaggeration, it always appears to me that a health provider charges $8million for something, then the insurance provider provides the “in network discount of $7.95million, and after deducting my co-pay, the balance is $00.00.   So I am so grateful for insurance but so perplexed by how all this adds up.  

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