PSA, from me to you. You’re welcome.Posted: November 30, 2012 Filed under: breast cancer | Tags: breast cancer in young women, breast reconstruction, DIEP reconstruction, Hibiclens, micro-mini pigs, mini pigs as pets, miniature potbellied pigs, Oncotype, post-mastectomy infection, the Big Dig 14 Comments
From time to time, I like to provide a public service announcement for the greater good. In other words, I learn the hard way — the expensive way — and share my lesson in hopes that some diligent reader out there in the blog-o-sphere heeds my words and avoids the painful/stressful/costly conundrums in which I tend to find myself.
Today’s PSA does not concern courteous driving (although perhaps it should, based on the overwhelming number of idiot drivers I’m surrounded by every time I venture out of my house). Today’s PSA will not address healthy living or how to fortify your liver for maximum alcohol consumption. Today’s PSA won’t even mention Pinktober, pinkwashing, or how misguided The Susan G Komen for the Cure organization has become. Today’s PSA doesn’t have anything to do with our little piggie (pity that, as she is infinitely entertaining).
Today’s PSA is all about how your health insurance company can — and likely will — try to screw you with the whole in-network/out-of-network debacle.
I recently had a surgery that, lo and behold, had absolutely nothing to do with breast cancer or breast reconstruction or breast reconstruction revision. How refreshing! I did my due diligence in researching a specialist who was the right guy for the job. I asked before I even made the appointment if he accepted my insurance. I provided all the nitty-gritty details insurance details before I saw the doc (ID number, group number, 800 number for claims). The benefits coordinator at the surgeon’s office reviewed everything on her checklist and assured me that we were good to go.
I saw the doc, he confirmed that the surgery was medically necessary and with just cause, and we scheduled a date. I paid my co-pay for the office visit and filled out all the paperwork, including multiple recitations of the insurance company details. I paid for my portion of the surgery well in advance. I followed all the rules (so I thought), and like a veteran soldier readying for battle, I eschewed any aspirin or blood-thinning products that can promote bleeding during surgery; I drank plenty of water the day before surgery to aid the anesthesiologist in finding a good, plump vein; I ate a healthy meal that would hopefully see me through being NPO the night before surgery; I washed the area to be sliced & diced with Hibiclens in my paranoid ritual of warding away any bacteria that might host a party in my surgerized body; I procured prescriptions in advance for the 2 antibiotics that are forever a part of my arsenal since that pesky post-mastectomy infection; I showed up before the crack of dawn on surgery day with an empty stomach and a powerful ache for my usual cup of coffee. I know the drill; been there, done that, multiple times. I got this.
Surgery was uneventful, recovery was long for my impatient self, but there were no complications.
Until I got a bill from the surgery center for more than $20,000.
20,000 clams for a surgery that was on the up-and-up and had been cleared for take-off well in advance.
After suffering a minor heart attack, I called the surgery center and was told to take it up with my insurance company. I called my insurance company and was told to talk to the doctor’s office. I called the doctor’s office and was told to retrace my steps and start over with the surgery center. Egads.
After spinning my wheels and listening to untold atrocious Muzak songs while on hold for what seemed like forever, I remembered that my insurance company provides a patient advocate service. I’d used this service with my previous insurance company and was forever grateful for my advocate, a former RN, who checked in on me post-mastectomy and throughout the course of the year-long infection battle. She intervened when the insurance company said it didn’t want to pay for the $5,000 Oncotype test, which dissects my particular cancer to determine the best way to treat it and determine how likely it is to recur. She helped me navigate the pages upon pages of medical bills that weighed down my mailbox in the early stage of my cancer “journey.” She was very helpful.
The new insurance company could take a lesson from her. Their patient “advocate” department sucks. I can barely stand to use the word advocate in relation to them (hence the quotation marks).
The first “advocate” I dealt with on this issue did some research and determined that the surgery center my in-network doctor used is out-of-network. So my surgeon is in-network but the surgery center is not.
Oh, and by the way, it’s my responsibility to check to be sure the surgery center is in-network.
Again I say Huh??
After all the checking and double-checking and verifying and pre-qualifying and certifying, I’m supposed to ask about the surgery center? How in the world would I even know to ask about this? What fresh hell is this?
Oh, yes indeedy, the “advocate” told me, I should have checked on that. And I should have known to check on that by reading the Standard Plan Description, a bazillion-page online document that details the ins and outs of my coverage.
While I’m grateful for the coverage I do have, I’m pretty sure my insurance company hates people like me who ring up millions of dollars in expenses for a disease they did nothing to cause and for which they actively tried to prevent. I imagine my file has a big red X on it to denote all the trouble I’ve caused and money the company has had to spend on my behalf. I’m guessing that when I call the insurance company with a question, the phone has a special ring, sorta like the Bat-phone, to alert the poor sap who answers it that I’m a raucous troublemaker who is bleeding their employer dry.
I get it. I’m not the ideal customer. But expecting me to verify that the surgery center is in-network is absurd. I don’t care what the bazillion-page online document says. If the doc is in-network and no one raises a red flag about the surgery center, then I assume I’m all clear.
A $20K bill and an instant heart attack are rather the antithesis of all clear.
And that, dear readers, is why I’m here today — to lead by example, to inform by the hard lessons learned. The word to the wise, learned expo-facto, is this: even if your doc is in-network, the surgery center may not be. Even if the doctor’s office staff have dotted every i and crossed every t, it may not be enough. Your insurance company my turn on you like a hungry dog on an alley chicken-bone and try to chew you up and spit you out. Consider yourself forewarned.
When I had my cancer surgery, I told everyone what my insurance was and asked if they were in network. Told them when I scheduled, told them when I checked in. After the operation I got a bill for $1,800, the anthologist was out of network.
A few weeks ago my daughter in college had a spider bite that started to send pink lines up her arm. It was Sunday, the college center was closed and she went to the ER. They looked at her, gave her a prescription for an antibiotic and sent her on her way. The bill, a cool $1,000.
Oh, yes! And you might want to check on the lab (they might be OON, and the radiologist who reads anything, same thing. So, basically, not only does one need to check with every service that he/she knows about, there may also be others who will be evaluating reports, analyzing tissues, or, like the person before me mentioned, the anesthesiologist, that it is also OUR job to “prescreen”. Oh, dear, indeed x 20,000 and I hope something can be done on your behalf!
Sadly you have run headlong into the difference between health care and health insurance. Your doctors may want to care for you. Your insurance provider wants to make money off of you. The bazillion page document is one tool to do that. If they really wanted to avoid the expense they would monitor your treatment AS IT HAPPENS so they could flag the out of network items. Instead they would rather catch it afterward because they make more money that way. It’s an ugly truth that, cheery ad campaigns to the contrary, the insurance company does not care about us.
Insurance companies are the real death panels, deciding what kind of care patients can and cannot have,
Goodness me, it never ends for you guys… I clicked ‘like’ on this post, but there should really be a ‘dislike’ button!
Praise be our National Health Service in the UK, but I fear insurance companies are the same the world over, I just think yours get more practice at being sneaky.
My hubs says your insurance company is just trying to kill you off quickly with the heart attack so they don’t have to spend any more money on you. 😉
PS Eddie and Cancer Curmudgeon have nailed some of the really ugly truths about our so called “greatest health care in the world” system.
I’m incensed! That is so outrageous! And not just the nasty insurance company situation but the amount itself – $20K for OUTPATIENT surgery?!!!! Are you kidding me?!! Do you have any recourse at all?
These insurance horror stories give me chills. So what will happen next? This is such a crazy system.
Nancy, my heart goes out to you (and my blood is boiling, too). I would first go after the doctor and his staff and their ignorance of insurance affairs. A really competent staff should know what insurance is accepted by the facility in which the doctor performs his surgeries. Did they pre-cert for you? Just the surgeon and not the facility?
Some surgical centers and hospitals contract out to an anesthesiology group. Within that group of anesthesiologists, some docs accept some insurance and other docs accept others. When it comes time for scheduling your surgery, the doctors are scheduled “blind.” So you don’t know who you are getting or what insurance they accept. Sometimes, when the anesthesiologist pops in for 3 minutes prior to your surgery to say hi, I mentally feel like asking them to confirm that they accept my insurance, or even being a smart ass and take a Sharpie marker and write insurance company name and ID number on forehead telling anyone not accepting it — need not touch me.
I am in the midst of BC hell and reconstruction-deconstruction-reconstruction and, like you, have a full time job of tracking insurance EOBs along with many hours on the phone correcting either the doctor staff’s mistakes or those of the insurance company. I fight to the bitter end, and have even told the insurance company rep that I’m sure glad they pay for me to see a therapist because that’s where I’m heading next to deal with my medical and insurance induced stress and will be racking up more bills that the insurance company will have to pay! And I made damn sure the therapist was IN network.
Nancy – while your post is in fact extremely helpful it still pains me (and more than likely everyone else) to know we are just pawns on this chess board. The word “advocate” is being tossed around like so many items colored pink during the month of breastober. Bonnie and I have been battling the same types of issues – not so much with the case you’ve laid out here but with ALL the little things the “advocate” could have been so kind to share but did not and we find out or learn about because Bonnie is at home with her god given talents, tenacity and dear I say it – the disdain and lack of trust for any big business; hospitals and insurance companies included. You’ve fought many battles these past few years and I pity the fool who answers the bat-phone the next time you call.
Then comes Dr. Nickel…your knight in shining armor. Love that guy!!!
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