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"Losing It"

Cpnqueen
Posts: 29
Joined: Nov 2011

Ok, I really need to vent because I am starting to lose it! I am hoping by actually writing this out I can ease my stress & anger.... How can insurance companies say things like a PET Scan are not medically necessary???? In the 2 1/2 months since my husband was diagnosed with Stage 4 Stomach Cancer that has already spread to his bones & lymphnodes, I have been flooded with denials and appeals and paperwork. Yesterday I was really starting to lose it with the insurance company and my husband's union since they are self insured. I was basically crying and yelling. I even said I felt like they just expected him to curl up in bed and die. I am so stressed emotionally and financially and I feel horrible that my kids (14 & 19) heard everything. I really wish I could just scream but instead I just cry. I am thankful for everyday I have with him and he is responding to the chemo but he is also in denial which means even more stress for me.

KTeacher
Posts: 874
Joined: Jan 2011

What can I say, we need it but they seem to think that they know what is best for us medically. I had surgery for mets. in July, luckily my radiation treatment is local. I really like, trust the medical staff at Stanford. In October I received a letter stating that we could no longer use Stanford (ugh). I had to get permission (from the pope!) to be seen by my surgeon, was told only to see doctor, no tests or labs. .. Happened to have a bump pop up on incision area 2 days before doctor visit. He wanted to biopsy, I couldn't--needed to get permission first (2 1/2 hour drive one way to Stanford) Had biopsy 2 weeks later, inconclusive--excised 2weeks later--scar tissue. Shouldn't have to wait. Luckily my insurance and Stanford are playing well with each other again. (Stanford was going to continue seeing patients with Anthem Blue Cross and sucking up the costs) My daughter had lap band (I know, not cancer) she couldn't have the surgery without permission from the insurance company, now they don't want to pay bills. It is very frustrating. Can you take a long soak in the tub or a walk. My sister used to go for a drive on the freeway and scream! You probably need to sit and talk to your kids if they heard the frustration, maybe go out for a soda or hot cocoa. They might be equally frustrated and not be able to express it. Glad that your husband is responding to chemo.

Cpnqueen
Posts: 29
Joined: Nov 2011

After more (calmer) phone calls a few of the denials are being reprocessed and the PET Scan is being reviewed. I noticed a coding error which will hopefully convince them! I actually went for an hour of cardio to ease my stress. It def helps! My kids and I talked and they seem to understand. All I know is this is just the beginning and I hope I learn to handle it better because I really don't want my husband to hear it or see my stress.
I am glad your insurance company decided to play nice with the hospital. Hope you are handling things well!

Cpnqueen
Posts: 29
Joined: Nov 2011

After more (calmer) phone calls a few of the denials are being reprocessed and the PET Scan is being reviewed. I noticed a coding error which will hopefully convince them! I actually went for an hour of cardio to ease my stress. It def helps! My kids and I talked and they seem to understand. All I know is this is just the beginning and I hope I learn to handle it better because I really don't want my husband to hear it or see my stress.
I am glad your insurance company decided to play nice with the hospital. Hope you are handling things well!

KTeacher
Posts: 874
Joined: Jan 2011

Keep records and write down dates and times that you talk to people at the insurance company. Keep a notebook handy and start a binder, you can get all of the lab and scan results and keep them with you. Usually the first person that you talk to does not have any authority to give you much information. Yes, I am so glad that insurance company and Stanford are playing well--I was so sorry for all of the people that were still in the hospital for treatment, I can't even imagine what they went through. (I found out that insurance legally had to cover me for a year because I had started with this before they started bickering). Glad that you were able to talk to the kids.

DrMary's picture
DrMary
Posts: 527
Joined: Nov 2010

Some hospitals have a social worker who will act as your advocate with the insurance company - might be worth it to talk the hospital or your doctor. Also, sometimes you get the right human being at the insurance company when you call - I had one carefully explain that she could not tell me which codes were best for my daughter's counselor to use on her bill, but if I asked her whether a procedure with a certain code would be covered, she could tell me. I was about to scream at her that I didn't know any of the stupid codes, and then took a breath. "I've tried some internet searches but only got a few of the relevant codes," I said, as calmly as possible. She replied, "I can't give you any advice, but I've heard that some people have found the complete book of codes at Office Depot." Got the codes, asked the right questions, asked the counselor to use this code rather than that code and got 50 minutes covered in a 1-hour session instead of 30 minutes. Wow.

Couchie
Posts: 24
Joined: Nov 2010

You should look into whether or not the hospital your husband goes to has a social worker. Ours did and she was wonderful. She helped to take care of all this stuff and when we get letters from insurance saying that won't pay something or we've used up our allotted amount of Dr. visits for the year, we hand the letter to her and she takes care of it.

palmyrafan's picture
palmyrafan
Posts: 398
Joined: Mar 2011

What you need to know is this:

Insurance companies make it a practice to deny coverage; either totally or piecemeal. That is how they save money. It is a proven fact that insurance companies will do this. They are hedging their bets that the patients will (a) not end up needing the test or exam, (b) will find a less-expensive test or exam or (c) will just be quiet, go away and (d) die.

It's a brutal reality, but it is what they do. Then combine that with the fact that many insurance companies' decisions are made, not by people who are actually medically professionals, but every day people who have been put in the position of making these decisions.

I am the patient (brain cancer) and my husband is my caregiver. We have BC/BS. When all my testing, exams, hospitalizations, etc. started picking up pace last year, we actually had a lady from BC/BS call us and tell us that she was my patient liaison from BC and that if we were denied without cause for a test, exam or hospitalization, we were to call her directly. She said to bypass the main telephone number that they give you because all we would get would be the call center with people who weren't qualified to make the decisions that needed to be made! We were amazed! We have never in 18 years of treatment had an insurance company treat us so well (her name is Robin)

It is difficult enough when you or a loved one are dealing with cancer and many times the insurance companies do nothing but complicate the issue. Robin told us that in the future, regardless of what insurance company we have, if we are ever denied, to APPEAL the decision. She said the majority of people don't do it because it is so time consuming and people don't feel like fighting the bureacracy. She said the insurance companies KNOW THAT and ARE COUNTING ON THAT.

Hang in there honey. Feel free to vent here anytime. We all do. Amazing what a little bit of scream therapy will do for you!

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