Putting Out Fires

Uggh, life's just hard!  You ever get to a point where you're just sick and tired of everything?  Lately I'm feeling like my whole existence is spent "putting out fires" ... taking care of problems, handling issues that we seem to be a magnet for.  House, business, family, relationships, kids, money, insurance.  There's not a single area in my life that isn't down on its luck right now! 

Today I'll share my health insurance woes.  This story is a doozy.  Last November, I was notified by my health insurance carrier that my PPO insurance coverage was being changed to an HMO plan.  I received the letter, and viewed it as simply an inconvenience.  I envisioned having to review the HMO that they were automatically moving me to and, if I didn't like it, having to go and find one that I did.  Who feels like doing all of that??  It wasn't until I saw this article in the Houston Chronicle in the first week of December that I was enlightened to what was really happening and realized the awful situation I was actually in.  (Too bad I didn't also see THIS ARTICLE and foresee that it would be affecting me, back in October)

It turns out that I was one of the 1,000's of policyholders in the Houston area whose PPO policies were being discontinued.  And the HMO that I was offered in its place?  MD Anderson was no longer "in network."  In fact, MD Anderson was no longer "in network" of any individual or Affordable Care Act's PPO's.  Suddenly we were scrambling to find alternative coverage that would allow me to continue receiving care at MDA, where I have been a stage IV breast cancer patient for over 9 years.  Having such a long and complicated medical history, it seemed impossible that I could simply switch to another oncologist.  Not only that, but I didn't WANT to switch!  I have long maintained that I'm alive today because of MD Anderson's care.  It's the #1 cancer treatment center in the world, after all.  Patients travel from across the globe to be seen there, and for good reason.  Hard to fathom that I, an established patient in active treatment, could no longer receive treatment there when I live in the Houston area.  I'm not just on follow-up, and I'm not cancer-free (and never will be.)  My life depends on regular chemotherapy infusions to keep my cancer at bay.

I explained the situation to my doctor, and was assured by her that MDA would do what they could so that I would have no gap in care.  Of course they were aware that this insurance issue would unfortunately affect many patients like me.

So, the scrambling.  I got in touch with the independent insurance agent superman (Ben) who had helped me through my last health insurance crisis (see this blogpost from 2 years ago) which by the way, had NOTHING on this current crisis.  He immediately went to work for me and after MUCH back and forth, documentation, email & phone communication and paperwork (and lots of worry and anxiety from me,) was able to set me up with a new plan that allows me to continue being treated at MD Anderson.  I've left out a lot of details, but I will just say that I am blessed to have this option available to me.  I want to add that I could have never navigated through all of this without Ben's help, and he even worked on my case and others' while he himself was dealing with health issues and recovering from surgery.  Thank you, Ben!!!

Backing up a bit ... to the process and its associated anxiety.  After much doing, Ben assured me that my coverage would take effect on January 1st.  He forwarded the details of my situation, including the fact that my next chemo was scheduled for the first week of January, to the powers that be (in the new policy department, or something) and we waited. Ben had done his part, I had sent a check in for the 1st month's premium, and all we could do was wait for the insurance company to do its part and "process" it all.  I was told that due to the sheer volume of new policy applications in 2015's last quarter, the processing and hence the issuance of IDs would be delayed.  So there was no guarantee that I would have verifiable coverage in the form of an ID card or ID number in time.  Even if my coverage officially took effect on January 1st, without the identifying information, it was as if I had no coverage.

On around December 30th or 31st, still having received no "official" word on the new policy, we went ahead and paid the January premium for the  crappy, MD-Anderson-is-out-of-network HMO policy, just to make sure I had SOME sort of health insurance in the month of January.  Let's face it, in my crappy state of health, a crappy policy is better than no policy.  Am I right?

Soooo, last week, while I awaited my chemotherapy appointment in the MDA infusion center's waiting room, (already a week late because the previous week's infusion had been cancelled due to low platelets) I was called in to a conference room by a "financial clearance associate" to discuss health insurance issues.  I was told that a "waiver" had been applied for, but MD Anderson was unaware that 2 separate waivers were required:  one for the facility and one for the physician.  The facility's waiver had been approved by the insurance company, but the physician's waiver application was still pending.  The associate then presented me with an estimate of the cost of the day's treatment, which totaled over $17,000, and requested that I acknowledge and sign the estimate, in case the physician's waiver was not approved.  Since I'm honest and know that I do not have the means to pay this amount of money, I declined to sign it and decided to forgo the day's scheduled treatment.  :(

 

The "waivers" we were discussing, I found out, were the HMO's attempt at working with MDA for patients like me in the midst of active cancer treatment.  They made MD Anderson "in network" for a set amount of time, even though they're actually not in network.  Still, what I really wanted was documentation of my new policy which wouldn't require the waivers in the first place.

 

Am I explaining this well?  Or is your head spinning just reading this??

To make a long story short (hahaha) ...
The very next day after being booted out of MDA (yea, that's what I'm going with,) I was able to obtain a temporary insurance identification card for my new PPO group policy.  I had some difficulty getting this new information through to the insurance department at MDA, but finally, FINALLY all is taken care of (I think) and I'm scheduled for my next chemo on Thursday.  I have only missed a week due to the insurance fiasco.  I say "only a week" but it feels like longer when it's my life that's at stake.  Supposedly, the insurance has been verified and I am good to go.  Fingers crossed!