I consider myself very lucky that I've never had to complain about insurance, until now.
Since BB is an outlier in his efforts to cure the disease, his protocols and testing are more rigorous than many. He uses MRI to track disease eradication, and he uses PET for the same thing as well as to provide measurements for precise bone marrow biopsies called fine needle aspirations.
I've just learned that my insurance company has rejected these tests, which means I either have to do without, or go out of pocket for several thousand (!!) dollars. I know this because I found out in arrears that they rejected the last batch and I need to come up with several thousand for that go-round.
It had been a pretty consistent dance over the years. BB orders advanced imaging. Insurance company refuses to approve. Somebody from the clinic does a "peer to peer" review with the insurance company and convinces them. They approve.
This time -- and last -- they did not approve.
Not sure if that's because of a change in policy or a change in personnel.
The reality is, whomever is the "peer" on the insurance end of the phone doesn't know this disease. That's why they are working as a minor administrative official in an insurance company, effectively stamping forms, instead of practicing medicine and treating disease.
As of now, the plan is go proceed with PET because that will highlight the presence of any lesions and can be used to guide the fine needle aspirations. I may or may not also get limited MRIs of my hip and spine, depending on what the PET says, I guess.
What a pain.
I have -- with a smidgen of effort, I must admit -- resisted the urge to make any political commentary so I would ask those of you kind enough to comment to also refrain from doing so. :)
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Hi Nick,
ReplyDeleteI'm wondering if you're eligible for charity care at any of the hospitals you visit. My partner gets 100% financial assistance at two teaching hospitals in Chicago. He was approved because his income is under $20,000 (that's not the cut-off. I think it's higher than that).
Josh
I had similar issues in the past. I've come to expect my insurance company to be inconsistent. Without exception, Tricot would always request a medical review/conference call with the medical doctors and explain why he requires so much diagnostic testing.
ReplyDeleteI usually check with UAMS MIRT Insurance to make sure they have prior authorizations from the insurance company before completing scheduled tests.
ReplyDeleteThat’s rather unfortunate! Is there any chance you could explain to that “peer” of your insurance the nature of this disease? Yes, they have no backgrounds about medicine or anything related, but they might change their decision if they could understand the complexity of the series of test you have to go through, and why you would need a financial assistance during the process. Every little thing helps. Good luck!
ReplyDeleteStacey Neal @ Romero Insurance & Financial Services