I
n dealing with trying to get another series of scans approved for my bi-annual CT's below is a letter to my company's insurance broker. Company names have been removed to keep my ass out of court, I hope. If I missed one, let me know and I'll remove it.
Insurance companies treat patients like we are trying to get something for free. Seriously it isn't as if cancer is fun in any way. It is scary as hell. It sucks. Even after you've made it to the other side, you get nervous with every scan wondering if it will show up again.
Dear sir,
I hope your week is going well. I
hope you are healthy and happy and enjoying the sunshine.
Just remember, you asked. Also
please know that I am venting here. This
has absolutely nothing to do with you personally.
This is the kind of thing My medical team and I have had to deal with every
6 months for the last 4+ years. It is a
pain in everyone’s ass.
I have been part of a clinical trial since January 2013. It will be ongoing for some time yet. I get bi-annual CT scans for this trial, it
is also nice to have bi-annual proof that the cancer has not returned. Nearly every time I go in for my appointment,
one scan has not been approved. This means
I need to reschedule to get the other scan on another day, taking time out of
work to go in. Sometimes I’ll get the
scans that have been approved and my Dr. will have to call in for a
Peer-to-Peer to get it approved while I am drinking the barium solution as I wait. Sometimes I end up having to reschedule the
scans or come back for the scans which were not previously approved.
eviCompanyX is the management company that does the approvals for
Insurance Company A. They do the approvals for most of
the scans for nearly all of the insurance companies. They have been the hold up for 95% of the
scans I have had over the last 4.5 years.
Here are the steps my medical team has to go through to get approval.
Scans are scheduled 6 months in advance.
1. Dr. office requests
approval by faxing in the information for each appointment 2 weeks in advance.
2. Get denied
because the request is sent in too soon.
3. Request approval
by faxing in the information again 1.5 weeks prior to my appointment.
4. Information sits
on the fax machine for a week.
5. Dr. office
calls to ask about the scans approval.
6. eviCompanyX says
they have no request.
7. Dr. office
sends the fax again and starts making calls.
8. Monday: I
get a call from Radiology saying my scans have not been approved.
9. I get on the
phone with the insurance company and start asking questions. They are not able to give any answers. I ask for a nurse case manager. They transfer me to their nurse call line, she
and I chat for a bit so she can get an idea of what is going on. She indicates that according to her screen I
should qualify for a case manager. She
has me listed as having Insurance Company ITC & BH Cond Mgt. She calls Insurance Company back to see about getting me
into these programs. Insurance Company says they don’t
see that on their end. They hang up and
she asks me to check with my HR person to verify if we have access to ITC as it
would be very helpful for me.
10. Tuesday: I
call insurance company asking more questions about scan approvals. They conference
in eviCompanyX who can’t tell me anything because I am only the patient. They only speak with medical professionals.
11. I ask to
speak with the supervisor.
12. After another
transfer I am told that they only got the request for approval Monday. I know for a fact this is not accurate as my
Nurse has informed me that they have requested approval 2-3 times by now. They say it may be approved and I should
check back with the imaging center in the morning.
13. Wednesday: I
call Radiology, they have not received approval.
14. I call my
Clinical Trial Nurse and she starts making phone calls.
15. I get a call
at noon from my clinical trial nurse who called someone in radiology who says
they finally have approval.
16. I leave work
at 2:30 to head to MCV for my scans.
17. I leave my
car with the parking guru’s and head down to imaging only to find out they
still don’t have approval.
18. I call the
insurance company and start asking questions again.
19. While I am
on the phone I text my Clinical Nurse about the approval. So she calls Radiology asking questions. It turns out that someone up in the radiology
office was reading from the wrong date on my chart.
20. Meanwhile I am
still on hold with Insurance Company. They are
trying to call my Nurse to get information from her.
21. My nurse has
her assistant call me to let me know she is on hold with the insurance company
waiting to get through, she doesn’t want me to think she has forgotten about
me.
22. I let the
insurance company know she is on hold with her people waiting to get
through. I end up being the go between
until they finally get connected.
23. The
insurance company person finally gets both of us on the line then attempts to
conference in someone from eviCompanyX. That
takes about 17 minutes, (they have the worst Muzak btw.)
24. We speak
with someone with eviCompanyX who has to transfer us to a medical review
secretary. We give my patient
information and find that the neck scan is the hold up. Again, they say they only received the
request a few days before but that they need more information before they can
approve the final scan.
25. I chime in
to let them know they have been the hold up with my scans on many
occasions. It is always the same one or
two scans they refuse to approve. I
mention that my Dr. administers all of the clinical trials in a major teaching
hospital that handles thousands of patients.
I then mention that this happens about 95% of the time. Most clinical trials require regular
scans.
26. My nurse
mentions that this is correct. Dr. Awesome ends up going toe to toe over and over on scans that occur regularly. At this point the problem is equivalent to a
corporate cancer of wasted time, effort ,and money for everyone.
27. Today I had
to reschedule my scans for July 31st as that was the next opening
they had in their schedule. This also
required me to reschedule my appointment with my oncologist, I don’t have that
appointment date yet.
So, I have spent approximately 8 hours on the phone with the insurance
company over the last week. I left work
early to make my appointment, had to pay $5 for parking to find out I can’t
have my scans unless I sign a wavier which the insurance company could use to
make me pay for the whole thing.
Don’t shake your head. This happened
in 2012 when I need a PET scan to determine how far the cancer had spread prior
to surgery. I’ve been fighting this crap
for almost 5 years by now. That PET scan
cost me $10k because the insurance company refused to approve it after the fact. My surgical oncologist was livid. He ended up doing 3 Peer-to-Peer’s trying to
get it approved. I could go on, but who has
the damn time? I do have that cluster
fuck written down for posterity. I
actually blogged about it during my treatment.
If you are interested go here for my blog post on that cluster from hell:
https://blkliesen.blogspot.com/2013/02/ (Trivia:
my oncologist uses my blog to educate patients on the immunotherapy for
melanoma. Yeah, if it happened it went
in the blog. I'm educational and shit.)
Now, I am out the 8 hours pay spent on the phone, 2 hours at MCV, $5 for
parking, and I still don’t have approval for said scans. I have also spent about half an hour on the
phone today trying to get rescheduled.
Since they couldn’t get me in until the 31st, now I worry
that the approvals I do finally have will be void and we will have to start the
process over again.
My patience has gone the way of the dinosaur. Insurance companies are making record profits
because they couldn’t give a rats colon about the people who buy in to their
policies. They refuse to be strait with
Doctors, Nurses and patients because they think we enjoy drinking barium which
bloats the hell out of you, getting poked with needles to insert an IV to ride
a machine to see if the cancer is back.
Then I get to spend the rest of the day in the toilet because nothing
messes up my gastric system like the chemicals used in CT scans. This is not like Disney land! There is nothing that is actually fun about CT
scans. Now, I know I make it sound like
fun, but really, it isn’t.
I am now waiting to see what comes of this. Wish me luck!
Update:
After a long conversation and requests to speak with a supervisor, I finally got through. I am not terribly confident that anything will come of it, and will have to check back but at least something is on record and they promised to push it up the chain. Here's hoping I can get some relief for my medical team. Heard from my Dr. today that he was on the phone for more than one peer-to-peer today. Insurance companies exhaust him.
