Getting the run-around

As anyone who has faced long-term illness or disease will tell you, wading through the medical bills can be a full-time job.

Luckily, I don’t have nearly as many bills to wade through these days. However, in Cancerland, the next expensive test and big bill can be — and usually is — right around the corner. The latest for me was a vaginal ultrasound in March to determine if my ovaries are up to no good after coming off tamoxifen. Yes, that’s right, a vaginal ultrasound. Don’t be jealous. It’s yet another perk for those of us in Cancerland.

I struggled long and hard with tamoxifen. I’ve written about my complicated relationship with the drug many times; most recently about the T-rage I had been experiencing. Like poor Bruce Banner, I was one Hulk smash away from wrecking something for good, and I didn’t like that.  I also had serious bone pain that got worse instead of better. I felt as if I were aging at a scary-fast pace. While the bone pain and aging were unpleasant, they weren’t deal-breakers. The T-rage, however, was a deal-breaker.

The T-rage was bad, really bad, but even worse is the increased risk of uterine cancer. For someone with a complicated family history of reproductive cancers, uterine cancer isn’t something I’m willing to risk. I’m not looking for a three-peat here; melanoma in 2006 and breast cancer in 2010 are more than enough for me. Throw in tamoxifen’s potential to cause liver as well and I’m downright spooked (with my affinity for champagne, my liver is likely limping along as it is. No need to tax it any more than my bubbly habit already does.)

I broke up with tamoxifen last fall. After three years, the side-effects were piling up like cars on Houston’s Southwest Freeway during rush hour. As much as I would have loved to have made it to the 5-year mark with Tamoxifen, it was unlikely; even more unlikely was being on the drug for 10 years, as is the current recommendation for pre-menopausal women.

Whether to continue taking the drug was a very difficult decision, and one with which I struggled. In the end, it came down to quality of life. Cancer and its far-reaching tentacles had already taken so much from me; I wasn’t willing to give up the slight hold I had on my sanity. It is a very personal decision. Much like the decisions that go along with surgery options and adjuvant treatments, what’s right for me might not be what’s best for the next person in Cancerland.

I’m far from alone in my decision to stop taking tamoxifen, however. This study of nearly 9,000 women with early-stage breast cancer revealed that only 49 percent made it all the way through five years. Younger women were more likely to quit their treatment, perhaps because of the far-reaching side-effects that come along with the drug.

As nasty as tamoxifen can be, just stopping it doesn’t mean the trouble ends. Because the estrogen my ovaries produce is no longer blocked by tamoxifen, the potential for that estrogen to feed hungry cancer cells is once again a very real possibility. The next-best option is having my ovaries removed, hence, the ultrasound in March that kicked off the latest round of harassment by my insurance company.

Yes, I am grateful to have health insurance and I am very sympathetic toward cancer patients who do not. The one thing that can make cancer more crap-tastic is to have to worry about going broke because of it. Being stressed about money is no fun. Add in all the hype about stress contributing to cancer, and the crap-tastic scenario becomes even crappier.

As was the phone call I received last week from the hospital where I had the vaginal ultrasound to determine what, if anything, was going on in my possibly ill-behaving netherregion. Here’s how it went down:

Her: “Hello, this is YaddaYadda So-and-So with the hospital you had your ultrasound at on March 20, 2014. I’m calling to collect the $508.40 you owe for that ultrasound.”

Me: (silently, to myself: Do not correct her horrible grammar. Let.It. Go. “at on” is not the worst thing a person can say. Even a person trying to collect money.) “Oh, hi YaddaYadda So-and-So.”

Her: “How are you today?”

Me: “Feeling like I’m about to become $508 poorer.”

Her: (silence)

Me: “hello?”

Her: “Yes, I am calling to collect $508.40.”

Me: “I have no idea to what you are referring. I have not received a bill for my portion of the ultrasound.”

Her: “So you did have an ultrasound on March 20, 2014?”

Me: “Apparently so, otherwise I cannot fathom why we would be having this conversation.”

Her: (more silence)

Her: “When can we expect payment for this unpaid service?”

Me: “When can I expect to see a bill for this service?”

Her: “It will be mailed out this weekend.”

Me: “So, you’re calling me to ask me to pay a bill that I have yet to receive?”

Her: “Yes ma’am. What kind of payment can you give me today?”

Me: “How about we wait on that? Maybe until I actually receive a bill?”

Her: “Ok, but when can we expect to receive your payment?”

Me: “Ummm, how about after I receive a bill?”

Her: “When do you think that will be?”

Me: “Am I being punked? Is this conversation for real?”

Her: (silence)

Me: “Here’s how it’s going to work: once I get a bill I will review the bill. Then I will check with my insurance company. Then I will pay whatever I owe. However, nothing is going to happen until I get a bill.”

Her: “Ok. Thank you for choosing our hospital. Is there anything else I can help you with?”

Me: “I’m not sure you’ve helped me with anything yet, so “anything else” is not likely. But thanks for asking”

Her: “Good-bye.”

The very next day, I get another call from another person in the billing department at my hospital. She, too, wanted to know when they can expect the $508.40 I owe. I told her, quite gently, that I have yet to receive a bill and that I had a conversation to the same effect yesterday, with her colleague. She seemed as dismayed as her colleague that I wasn’t ready to fork over $508.40 for a service for which I’d yet to see a bill.

Two days later, still no bill, but yet another phone call from yet another person in the billing department. I told her that she was the third person to call about a bill I had yet to see. I asked her to please put a note in my file that says Do Not Call Me Until the Bill Has Been Mailed. And Then Wait a Couple More Days to Give Me Time to Go to the Mailbox and to Read Over the Bill.

At this point, my patience had worn rather thin.

After doing some investigating with my insurance company, I learned that the claim had yet to be filed. I duly called the billing office of the hospital to report my finding. I left a voice message stating my business; I suppose all the billing representatives were busy on other lines, cold-calling customers asking for payments for bills not yet process, mailed, or received. I felt comfortable ignoring the two voice mails the billing department left me while I waited for the bill to arrive.

Today I got a call from yet another billing representative, telling me that they got my voice mail and were calling me back to take my payment. Here’s how that convo went:

Her: “Yes, I’m wondering how you’d like to pay the $508.40 owed on your account.”

Me: “You mean the $508.40 about which I left a voice mail, saying I checked with my insurance company and no claim for that service on that day by this hospital has been submitted?”

Her: “Yes ma’am. How would you like to pay?”

Me: (silence)

Her: “May I place you on hold, to verify that the claim has been processed?”

Me: “You call me, then want to put me on hold? So you can check to see if there’s a reason for you to have called me?”

Her: “Uh, yes. Ma’am.”

Me: (sigh) “Ok.”

Her: “Ma’am, we show that your insurance company just submitted payment for $1249.10 today. They just paid today.”

Me: “Ok. Great. So we’re done here?”

Her: “Um, I think so, but let me double check. May I place you on hold?”

Me: (sigh) “Ok.”

Her: “Yes ma’am, your insurance company paid the $1249.10. Today. They paid today. Just now. I don’t see that you owe any deductible. But, um. How would you like to pay your portion?”

Me: “My portion of what? You just said I don’t owe any deductible.”

Her: “Um, that’s right. I don’t think you owe anything at all”

Me: “So we’re done here?”

Her: ” Yes. Is there anything else I can help you with today?”

Me: (sigh)

Here’s what I want to know: does the hospital make such phone calls soliciting payment on purpose, hoping the recipient of the call will just pay whatever amount they’re told, right there over the phone? Or is the billing process complicated enough to warrant the kind of confusion that results in a customer receiving multiple phone calls asking for payment for a bill that’s yet to be received?

Or was I being punked?

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Becoming Benjamin Button

I haven’t seen that movie, but I feel Benjamin’s pain with premature aging. I don’t recall anyone telling me in the early days of this cancer “journey” that being thrown into menopause a decade earlier than normal would be such a bear. In fact, I don’t recall hearing anything at all about being thrown into early menopause. Yet another lovely bit of fallout from a cancer diagnosis, for sure (insert a boatload of sarcasm here).

Menopause is a bitch on any level. It’s certainly not a contest, and some women have it way worse than others. I’m thinking of one darling friend in particular who’s been dealing with the ‘pause for 10 years. Yuk. It just sucks, and I’m because I’m officially old and crotchety, I’m not in the mood to look on the bright side or try to find something positive about this shitty situation. Correction: I just found something positive — it gives me an excuse to use the word shitty, one of my faves in the cursing arsenal.

I first came face-to-face with chemically-induced menopause two summers ago when my favorite oncologist recommended hormone suppression since my breast cancer was fueled by estrogen. Get rid of the food supply, starve the cancer; makes perfect sense. Suppressing the estrogen for me was achieved by the dynamic duo of Tamoxifen and Lupron. For the lucky uninitiated, Tamoxifen is a pill-form of chemo that we members of the pink ribbon club take every single day for 5 years, minimum. The Lupron is delivered once every three months via a gigantic needle that left me bruised for weeks.

Enduring the injection was a piece of cake, though, compared to the side effects of Lupron: constipation, joint pain, bone pain, general body pain, dizziness, hot flashes, fatigue, stuffy nose, nausea, sweating, insomnia, weakness.

Great.

Add that to the side effects of Tamoxifen–bone pain, hot flashes, loss of balance or coordination, persistent fatigue or weakness, among the highlights–and you’ve got a hot mess.

No wonder I feel bad.

Then I look in the mirror and I feel even worse.

Side effects of menopause are just as fun as the drugs’ side effects: hot flashes, osteoporosis, hot flashes, mood swings, hot flashes, changes in your female gear, hot flashes, mood changes, hot flashes, change in vision, fatigue, hot flashes, night sweats, hot flashes, joint pain, hot flashes.

Did I mention the hot flashes?

The combination of the drugs’ side effects and general menopause side effects are mind-boggling.

The unsung side effects from all this mess are mostly vanity-related but no less troubling. A thinning of the hair on one’s head accompanied by a growth spurt in the hair on one’s face. Decreased collagen in the skin. Dry skin. Dark circles under the eyes. Brittle nails. Wrinkles. More wrinkles. Changes in hair color and texture.

Any part of this would be unpleasant enough when dealing with it at the “normal” time, whatever the hell normal is anymore. Going through the ‘pause with girlfriends could be fun: let’s stay up all night, sweating and hot-flashing, while watching our moustaches grow. Sure, we’ll be extra tired and grumpy the next day, but hey — we’d be tired and grumpy anyway, right? If I’m going to become an old bitty before my very eyes, I want to do it with my BFFs.

But wait, I’m on an accelerated schedule. I’ve got the Fast Pass to menopausal hell, while the women in my peer group are still relishing their early 40s. Botox is for fun, not necessity, and plucking billy goat chin hairs is reserved for grannies. 40 is the new 20, right? Except for me; 40 is the new 60. I am the granny in this scenario. I’m feeling more kinship with Betty White than with J-Lo.

To quote Sheryl Crow, “No one said it would be easy. But no one said it’d be this hard.”