Archives for posts with tag: oncology



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.

So I guess this must be the easy part.  The surgery to remove both breasts and a couple of nodes occurred early Tuesday.  I am already showering, changing my own dressings, dumping grenades, and off pain meds.  My situation is slightly different from most because I elected not to have reconstruction.  I’m 56, single and just made the decision to forego adding breasts back into the mix.  So I don’t have spacers or anything else in there, other than drains.  All is well.

Daily nurse visit has been excellent.  She checks my vitals and dressings and drains and teaches me the things I need to know in order to take care of myself.  My sisters and friends have been beyond believable and I am more grateful than I can convey.  

Monday prior to surgery was excruciating but by Tuesday morning I was feeling calm and peaceful and relieved that surgery was the next step. 

Now, I have follow ups and visit with oncologist to determine proper course of action.  Already knew I would be radiated but may need chemo as well.  Maybe this is when the hard part kicks in.

It is my nature to fight.  So cancer, beware.Image

  • 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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