In a fit of pique

After going  around and around with the insurance company, I finally wrote them a letter.  Here is the first draft, names have been changed to keep me from being sued by these blood suckers.

To whom it may concern,

I am greatly concerned with the lack of care which has been taken with my case. The finger pointing has got to stop. 

1.       I was first diagnosed with Melanoma in March 2009.  My Surgical Oncologist took the margins March 4^th, 2009.  At that time, the dye did not drain to a lymph node so none was taken.

2.       I was again diagnosed with Melanoma in October of 2012.  My doctor ordered a PET/CT scan which was denied by <insurance company> 11 October 2012, the day before I was scheduled for the PET/CT scan.  The woman on the phone showed little care that I was facing a potentially deadly disease.  She was merely given the odious task of letting me know that <insurance company> felt the PET/CT scan was unwarranted.  She had no answers for me so she forwarded me to the Nursing staff to answer my questions.  The nurse I spoke with was not impressed with my desire to rid myself of the cancerous tumor growing within me.  She said the PET scan was not covered for Melanoma.  I asked at that time for the <insurance company> Standard of Care documentation and was informed by the afore mentioned nurse that she did not have time to forward said document to me as she was only there to take calls and answer questions. 

3.       I repeatedly requested this document over the course of several weeks.  I even enlisted the assistance of my HR director to forward the request for me. 

4.       We appealed this decision and were once again denied, I was told that my Dr. would have to do a Peer to Peer review. 

5.       At this point it had been several weeks and I still had a deadly cancer growing in my right arm.  I did not feel there was time to wait on the <insurance company> appeals process to have it removed.  I elected to get the PET/CT scan so that I could schedule surgery and have the tumor removed.

6.       The PET/CT scan showed that the tumor was confined to my upper right arm so we went ahead and scheduled the surgery. 

7.       My Dr.’s staff applied for and received approval for surgery.  I went to MCV for surgery October 24^th to have the tumor removed and to have a sentinel node biopsy.  The surgery went well.  The tumor ended up being in a lymph node in my upper arm but the sentinel node was clear.

8.       I have since been informed that <insurance company> would indeed not approve the PET/CT scan and have lost the appeals. 

9.       I have had several meetings with the <insurance company> Sales people who represent our company.  I had informed Ms. Insurance Rep in October that I had still not received the <insurance company> Standard of Care.  I informed her of the treatment I had received over the phone with the <insurance company> Nurse.  She informed me that she would indeed look into my case.  A few days later she called me and apologized for the lack of care I had received.  She indicated that she had spoken with the nursing supervisor who said that the nurse I had spoken with did not take my request seriously.  Apparently she thought I was a prank call?  Or maybe she was having a bad day and I drew the short straw?  I neither know nor care.  This treatment is unacceptable.  During this phone call she did inform me where I could find the <insurance company> standard of care on the <insurance company> website.  This took all of 5 minutes.  Why the nurse couldn’t direct me thusly, I have no idea.  Ms. Insurance Rep also indicated that she would further check on my case.  I also received a hard copy of the <insurance company> Standard of Care in the mail November 12^th, 2012. 

10.    I did finally receive my final rejection letter for coverage from <insurance company> November x, 2012.  The National Coalition of Cancer Network Standard of Care was cited in the letter.  However, when I looked up the NCCN Standard of care it still did not match that of the <insurance company> Standard of Care.  Further I looked up the American Cancer Society Standard of Care which was similar to that of the NCCN.  I have spoken to several medical professionals who all agree that the PET/CT was the appropriate diagnostic tool for my case.

11.    The second meeting I had with the <insurance company> sales people included 2 other gentlemen who didn’t say much.  I still feel their excuses are merely that, excuses.  I was informed that my case had been handled poorly by the <insurance company> Staff but that their hands were tied and they could do little but check into things.

12.    I again received a call from Ms. Insurance Rep who indicated that she recommended filing the BOI with the State of VA Insurance Commission.  She also indicated that my Dr. did not forward the clinical data on my case that would have approved the PET/CT scan.  Apparently this information did not come up during Peer to Peer conversation either?  I think not.  For a company such as anthem to blame my Doctor for not forwarding the appropriate information is ludicrous.  My Dr. is a well respected Surgical Oncologyst. 

I also sent copies to my state and federal representatives.  To date I have received 2 replies out of 6 letters.  I am not confident in our legislators to actually give a shit, because they are the ones who gave so much power to the insurance companies in the first place. 

I say we fire them all and start over!

To catch you up

Where to begin...

Oh yes the disclaimer; you may on occasion run across some foul language in this blog.  There are some things that raise my ire in life.  Dealing with insurance companies is at the top of that fucking list.  It is what it is...  While I will attempt to clean up my language, there are times when an explative expresses the sentiment better than anything else can, so I will probably use it.  I apologize for those who are offended by this, but again, it is what it is... 

In March of 2009 I was diagnosed with Malignant Melanoma.  In April of 2009, I had surgery to take margins and a sentinal lymph node removed.  Sadly my body did not cooperate and the radioactive dye didn't drain to a lymph node.  My Doctor said out of more than 500 patients I was one of 3 who didn't drain to a node.  Proof that I am a genetic anomaly?  Maybe.

September of 2012 I found a lump in my arm not far from the original melanoma site.  To be honest, this freaked me out a little.  Part of me knew what it was.  I immediately made an appointment with my oncologist.  Have I mentioned I was freaked yet?  Yeah, scared shitless actually.  So, I go see my Dr. who takes one look and says, "Stay here until the pathology guys come down to get a sample, then you can go to work and I'll call you when the results come back."  Now, my Dr. has a great poker face, but I'm pretty sure he knew what it was immediately & without any test.  He called me 2 hours later.  They didn't even have to run the lab on the sample.  What they saw on the slide was more than enough proof of it being melanoma.

This was a rather large and violent kick in the ass.  I called my folks to let them know and my mom said, "I'll see you Friday."  I tried to disuade her as nothing had been scheduled and I had no idea how long it would take to get tests & surgery set up, then there was the recovery time.  Was the Dr. going to have to take part of the bicep or just the tummor?  Mom, however is persistant and didn't want me to be alone.  So out she came and we had a lovely month hanging out. 

Be aware that insurance compaines are evil and will try to get out of paying for things.  I am still fighting them over a PET/CT scan.  Seriously, the first denial I got, they tried to tell me it was experimental.  Then they said it was something else, finally they tried to tell me it wasn't Standard of Care.  Really?  Seriously?  I looked it up.  It IS Standard of Care for recurrant melanoma!  Douche Bags!

Now, I can't really blame the poor schelps who answer the phones.  They are only reading the crap someone else put in their computers.  However some jack ass input the lies these poor people had to quote.  Yeesh!  then when you ask questions, they haven't the expertise to answer so they are sitting there sputtering into the microphone at you.  Somewhere in there I was directed to the Insurance Co. Nurse who was supposed to be honest and answer my questions.  Sadly I got a surly bitch who thought I was joking about the whole cancer thing.  Like I enjoy riding in a claustrophobic machine unable to move for fun.  She couldn't get me a copy of the Standard of Care as she was too important and that kind of work was beneath her.  She said she would pass my request on.  Note:  She did not pass on my request.  I had to ask 5 times to get the standard of care and it took about a month.  All the while I have a deadly cancer growing in my right arm.  Mom and I decided not to wait for the insurance company to pull its collective heads out of its very large ass.  We got the test, and had the surgery.  Sigh of relief!

The surgery:  it was outpatient, thank heaven and pretty much killed my deductible in one fell swoop!  Yay!  Sadly I had to some up with that money to pay the bill. Booo!  The surgery itself was really no big deal.  I went in that morning, I was under for less than an hour, I was on my way home.  I even cooperated this time, the radioactive dye did drain to the sentinal lymph node which they took and sent out to be biopsied.  Sadly, the tumor was in a lymph node so not all good news.  I had my friend Ruth drive as Mom doesn't know her way around Richmond, and that would give her someone to sit with while I was under the knife.  They had to take more tissue this time so the scar is larger, and angrier.  I also have a scar under my arm where they took the lymph node.  It also took a little longer to heal this time.  I used a sling because the skin was tight and it felt better to keep it protected. 

A few weeks after the surgery, the insurance company had denied me again, they had a meeting at my office to ask questions of our insurance rep.  I went, I waited patiently until the meeting was over, waited fro the room to clear out, cornered the rep, and let loose.  She was appaled!  She promised to look into it.  Yeah, whatever!  I had heard that from my HR person already.  Hot damn, she called a few days later to let me know that she did in fact look into it and yes, everything was handled badly.  She is the one who finally got me to where I could download the Standard of Care from the craptastic insurance co. website.  Now when I say craptastic, I'm being generous.  Cumbersome is too generous a word for that site.

O.K. I am getting tired and it is time for bed.  More to come.