This Time of the Year

I’m coming up on my diagno-aversary.  Is there such a word?  If not, I’m claiming it.  A week from today will be 4 years since my office diagnosis.  And even though I have had appointments, blood work, and recent surgery which show me as NED (No Evidence of Disease), I still get the heebie jeebies.  I don’t think that will ever go away.  Ever.

On the hernia recovery front, each week has gotten a little bit easier.  My tummy and abs are still very tender.  The area where the mesh was put in will be sore for a while.  My surgeon is kind of awesome – he doesn’t sugar coat things.  I asked him how long that would hurt, and he basically told me, “Until it doesn’t hurt anymore.”  LOL

I’ve been back at work for a week now.  And, as usual, when I have had to file a claim for Short Term Disability with Metlife, I’ve been screwed out of a week’s pay.  My case manager is horrible and she doesn’t return calls or communicate at all.  She asked me to call her on the 1st (the day I saw my surgeon) and give her an update on my status.  I did, as well as faxing a copy of the letter I got stating I could return to work on 8/8.  I also had my surgeon’s office send over the office notes and other supporting information.  I confirmed all of this stuff had been received on 8/3.  This past Saturday, after I called and left several messages asking the status of my case, she FINALLY left me a message (with no call back number) telling me I had 1) not called her on the 1st (bull – I had the name of the person I spoke with because she was not answering her phone); 2) had not provided the requested information (again, had confirmation all faxes had been received on 8/3); and 3) hernia repair surgery only requires a 2 week recovery time.  Yeah – I guess if that is the only thing you are dealing with.  I sent her another SCATHING email this morning, with everything she requested.  I had my doctor’s office fax over the stuff again.  I also laid out for her each time I had called, who I spoke with, and what was faxed.  I also informed her that perhaps if HER paycheck had been $1,000 short, she’d think differently about her nasty voicemail.

Sigh – I guess I’ll continue to fight for what is mine.  Always.

In other news, I am feeling better.  Work is work, and life goes on.

 

Great Insurance

As a cancer patient (who will forever be a cancer patient, remission or not) and I can not tell you how thankful I am for insurance. Cancer patients in Delaware do not have to pay for their first year of treatments. Too bad I lived in MD when I was diagnosed.

Now, I’m not going through treatments, but the treatments left a lot of nastiness behind. The treatments are what ate away the rest of the cartilage in my knee. Treatments have caused a huge amount of atrophe and “shrinkage” in the ladybits which have required additional treatment and believe it or not, physical therapy. Plus, I have follow-ups from oncology, and my usual six month cardiologist checks to ensure the ticker is still working in great order after the heart attack in 2003 (nearly 11 years ago!).

All of this cost money. Now, I don’t know about you, but I haven’t got a money tree in my back yard (but wouldn’t THAT be awesome). Thankfully, I have insurance. Now, not that Anthem BlueCross BlueShield is in anyway user friendly (see a few of my posts prior to my knee surgery) but it does pay for great things.

Seriously?

I’m kind of at my wit’s end with my health care providers today. Not necessarily the doctors, but the idiots who run the customer services units leave a lot to be desired.

My MRI was rescheduled because I had to have a pre-authorization for the scan. OK, no problem. Never had to have a pre-auth for ANYTHING with BlueCross before, but my provider changed from Empire Blue Cross to Anthem Blue Cross this year when I moved to Delaware, so that could be why. So, I rescheduled my MRI for this Tuesday, called my ortho’s office, made sure they had my NEW insurance information, and asked them to take care of it. Those guys are fantastic.

An hour or so ago, during my work day, where I am on the phone 90% of the time, my cell phone rings with a number I don’t know. I was on a conference call so I let it go to voice mail. I had an automated message with someone who gave me this number and asked me to call them back regarding my Health Plan. WTF? Who are you? So when I finally had some time with my lunch I call them back. This girl answers, does NOT identify who she is working with, and I tell her that I got a message and was asked to call back. She says, “Ok.” Then proceeds to ask me for my date of birth and social security number. Uh, no. I said, “I’m not going to give you that…I don’t know who you are.” She says, “You called us.” I said, “No, I returned YOUR call.” Oh – well we’re Anthem Blue Cross. Then why didn’t you answer the freaking PHONE that way?

So I give them the information they referenced and they let me know that my MRI had been authorized. Then she goes on to tell me she wants to help me schedule it. Uh, no. It’s already scheduled. She says, “Well, I can save you some money.” Ok. Then she says, “We want you to have the MRI done at Upper Chesapeake Facility in Bel Air, MD…it will save you $15 on the total cost of the MRI.” Uh, no. Nope. NO. I said, “Why would I want to drive an 80 mile round trip which will cost me $40 in gas to save $15 on my MRI?” Well, this facility will cost you less.

No…no it won’t. It will cost me more, and I can’t charge my GAS to my flex account for medical expenses. I asked her if there was a problem with the facility I had chosen (which is a MILE from my house). No…but it will cost you $15 to $20 more to have it there.

I lost my sh*t. See, I had already been on a call this morning with Express Scripts to find out why in the h-e-double-hockey-sticks they don’t give me a full month script on my anti-anxiety meds. I take 3-a-day. 3-a-day for 30 days is 90 pills. EASY MATH. So why do they proceed to send me 20 every month and then tell me that I can’t get them refilled until the next month? The girl I spoke to there was a moron too. I asked her to READ the SCRIPT from the doctor. OH…well, you should be getting 90 pills. YOU THINK?

Sigh.

So back to Little Miss Anthem….who tells me in the FUTURE I should order my procedures though them.

NO – if I have determined that the facility I’m using is IN NETWORK, then I’m going to make the most convenient appointment for me. NOT FOR YOU. She tells me, “Well, your doctor is in MD.” Yeah, because he’s the BEST. And the ONLY doctor who will do this surgery in the Mid-Atlantic area. I also tell her, “My knee hurts. I need surgery. The only way you people will pay for the surgery is if I go to PT which is making my knee WORSE and then having an MRI…I’m following your rules. I pay a lot on a monthly basis for you people to WORK FOR ME.” Then I hung up.

Yup, lost my sh*t.

It’s a good thing I didn’t have to deal with this during cancer treatments. Because I think I would have elected to just stand in front of a microwave and hope the radiation worked.

Plugging Along

Sadly, I still can not disclose any information on our (fingers crossed) good news…thanks to a long weekend and now a snow day that has shut down government, I’m sure we won’t hear anything until later this week. But please, continue to send some good juju our way. We could use it. And no, I’m not pregnant. Not adopting. Just some good news finally coming our way. 🙂

So, this weekend, I decided to bite the bullet and change my eTools membership with Weight Watchers to an actual in person Monthly Pass. I got up Saturday morning, bright and early, and took myself to my first meeting in I don’t know how long. Since before gastric bypass. I am still up from the cancer diagnosis, but I enjoyed the meeting, and honestly, the Simple Start program is easy peasy – no counting, no special food…just eat from a list of “approved foods” and add in an indulgence once in a while (you can count up to 7 points per day) and it is something I’m loving because I don’t like thinking about it. The recipes are pretty good as well, although I’m twisting them my own way with seasonings and flavors. We’ll see how it all comes out this Saturday at my first “official” weigh in.

It’s snowing here. Again. This has been the worst freaking winter. Normally I really don’t mind the snow all that much, and I do have the ability to work from home as I need to now without an act of God from my supervisor and a guilt trip from hell. I was supposed to work from home today anyway, as I had a dentist appointment this morning, so hey, it worked out. I really don’t like the cold or snow because of what it is doing to my knee and other assorted arthritic joints.

That kinds of leads me into my next bit of news. Surgery is 100% in my future. I saw my ortho yesterday for a knee check. He told me that the amount of damage in my left knee is extensive, and this time around, he can not even guarantee he can do a de novo graft (the surgery I had on my right leg in 2011). He thinks the damage to the underside of the knee cap (where he would graft the new cells) might be too much to guarantee adhesion. We discussed other options…the one that frequently came out of his mouth was full knee replacement. OK, folks, this freaks me the hell out. First, I’m only 41. Which means without a doubt, I will have to put myself in this position again in 20 to 25 years if I get the full knee. It’s a big surgery, and my system isn’t making me any guarantees between the diabetes and the cancer. Additionally, due to my age, getting my insurance to pay for a full knee replacement now might be a crap shoot. I told him this option was the LEAST appealing option to me.

We also discussed doing another scope and clean out, and when he does that, he’ll realign my knee cap. The whole reason I’m having issues with this knee was not because I was over weight (although that had a lot to do with the EXTENT of damage) but because I disclocated my knee in highschool. It was never properly set. Five years ago, I had a microfracture on this knee, and a lateral release done on the knee cap to move it from the side of my leg back to the center. In the past five years, the knee cap has become like Mae West…she used to be Snow White, but she drifted. This sugery is 100% in my future at the very least.

Finally, we talked about trying the de novo graft (they graft young cartlidge cells to the back of my knee cap to encourage new growth). He’s IS willing to try it because I told him I didn’t want to hobble around for the next 20 years, or dive right into a total knee replacement without exhausting everything else first. What he did tell me was that he’s ordered an MRI, and if he gets in the knee, and doesn’t like what he sees, he won’t try it.

Many people would ask why I would pick the de novo over the total knee replacement. Honestly, the total knee replacement is an easier surgery. I’d be up and around that day walking on the knee. It’s not a difficult recovery. But it is a shock to the system, and knee replacements only last 20 to 25 years max now. I don’t want to do this all over again if I don’t have to. The de novo graft is an outpatient sugery, but the recovery sucks. It’s very painful, and I will not be able to bear weight at all on my knee for 8 to 10 weeks. Also, I will be in an immobilizer for 8 to 10 weeks, which means when my knee is ready for PT, it is horrible. But, the sugery can PUT OFF a knee replacement for 15 to 20 years, which buys me a lot of time if it is successful. And that’s what I’m counting on.

So, I see the doctor again in two weeks, and he’ll have my MRI results then, and I think then we’ll figure out what the road map to this is. I can’t keep going on like this – he knows he has to do something, because it is affecting my ankles, my back, and my hips. And hip pain scares the blue purple bejesus out of me since it is what led to my cancer diagnosis.

So, send good thoughts that I can get a de novo done…I’d appreciate it. And keep swinging those chickens for our other good news. 😉

And wish me sanity between now and the Superbowl. The Broncos are in and my husband is riding high. Me, I’m annoyed that my team was one and done and am protesting football until pre-season next August. GO IGGLES!

Is There A Big Old Bruise on my Forehead?

Because I’ve been beating my head against a brick wall with Blue Cross Blue Sheild.

My bill last December from Radiation Treatments and Brachytherapy was $24,500.  And no, I didn’t mess up the decimal point there.  $24,500. 

I am one of the lucky folks who have employer paid insurance, and I pay extra for the Blue Cross/Blue Sheild insurance because just about every doctor in the US takes BC/BS.  And my benefits are relatively good – I have a $500 per person out of pocket deductible ($1000 for both of us together) and after that, a 90/10 responsibility – insurance pays 90% and I pay 10% – for all covered expenses.  And miraculously, they cover just about everything….just about.  I also have a $3,000 out of pocket ($6,000 for both of us) personal responsibility before insurance kicks in and pays 100% of all covered expenses (too much math too early – I know…I’m sorry).

So, last December, when we I was pushing through daily radiation treatments, and then 3 of the most horrible brachytherapy treatments, I really didn’t think about out of pocket costs.  Cancer treatments quickly eat up that $3,000 out of pocket.  I hit in in August – just after my diagnosis.

Blue Cross decided in March that they didn’t want to pay for my brachytherapy.  Too experimental.  Except its not anymore.  So I got a bill from UMUH for $4,500 – the cost of my three brachytherapy treatments.  What they told me was they needed more information to determine if the treatments were, in fact, necessary.

Because, you know, Cancer is not necessary enough to go through radiation treatments in your hooha.  It was something I decided to do for shits and giggles…you know?  Oh hey, nothing to do this Christmas break…let me go endure having a radioactive rod shoved into my nether regions…you know, because I’m not already sick enough.

So, after months of arguing, and fighting, and fussing, and finally getting my radiation oncologist office to send enough studies to Blue Cross to acknowledge that yes!  Yes this was a necessary treatment!  Hurray!   The treatment was in fact, necessary and yes!  Yes they will pay it!  This was in September.  I didn’t think another thing about it, and went on my merry way.  Until I got another collection call from UMUH.  They only paid for two of the three treatments.  *insert primal scream here*

So I still owe UMUH $957.  I called back at the beginning of October and spoke to “Rob.”  Rob was clearly not at the top of the brain chain.  But, after putting me on hold for 15 minutes (this is 10 months after my radiation treatments ceased) he comes back on the line and says, “Oops.  It appears we *forgot* to pay that charge.”   Rob assured me he’d send it to processing and it would be paid.  Because there was no reason not to pay it – the three treatments were the same.  They paid for two…so why not #3?  Because, well, Oops.  They forgot to.

Uh, what?

Now, this last call with “Rob” was a month ago.  I assumed it would be taken care of, and went back to my business.

Until today.  When I got ANOTHER EFFING Collection call from UMUH.

Insert head banging here.

I called Blue Cross back and spoke to Sam.  Sam sounded as if she had taken a handful of downers before she picked up the call.  She said, “That charge is showing as experimental – we need more information.”

Whatthefuckingfuck?

Sam may feel as if perhaps she should have stayed home today, because she got a royal ass chewing.

I explained to her the situation.  I told her that all three brachytherapy treatments were the same.  ALL. FUCKING. THREE.  So, Sam…can you explain to me why Blue Cross paid for two, and not the third?

It’s under review.

You have to be kidding me.

Seriously.

I’m still looking for the top of my head because it blew off.

When, my dear Sam, did it go down for review? 

October 1st.

Today is the 29th.  Any chance in hell that they are going to make a decision on this soon?

Well they have 30 days.

Seriously. 

I can’t, for the life of me, understand this situation.  But if it isn’t paid by the end of this week, you can rest assured, I’m calling back.  For the 8 bazillionth time.  And Sam and Rob, please don’t answer the phone.  You won’t be happy if you do.

I have called three times over the past two months

Uphill Climb

I mean to tell you, these past two weeks have been rough.  Chemo this time around is much worse than it was the first three times.  I suppose that makes sense, since the drugs build up in your body, and I did just finish 28 sessions getting french fried before I started chemo this time around.

My veins, which used to be strong and pop up at the drop of a hat, now run and hide when it comes time for chemo and blood word.  When I went on Monday, it felt like the poor woman was digging for gold just to get three small vials.  And I drank a ton of water ahead of time, so I’m really not looking forward to this coming Monday when it is once again time for chemo.  If I had more than two left, I’d opt for the port, but since I only have two sessions left, I just can’t bring myself to have another surgery – even an outpatient one.  So, I’ll make sure to drink a ton of water this weekend before chemo.

And my blood work still shows a compromised immune system and anemia.  It’s better than last week, but still lower than it should be.  I’m not confined to the house this week (thank you Jeebus) but I’m supposed to avoid sick people and people under 12.  Little ones are big old germ breeders.

My hair started coming out again yesterday.  I don’t know why this is bothering me so much.  I mean, I know it will grow back.  I know it will.  But it just seems cruel that I have just gotten to the point where I can wear a pixie cut and now it’s all coming out again.  We are not shaving my head this time unless it gets bad though.  It’s too cold.  More is falling out faster this time.  I see it in the shower, in the sink when I comb in delicately, on my pillow.  And it’s coming out everywhere *ahem*.

I’m tired all the time, and everything I eat makes me queasy, so I’m boosting myself up with protein shakes.  At least this time around I can drink my coffee.  I need my coffee.  Believe me.

I keep thinking – just two more to go.  Six more weeks.  But if it is this bad now, what is it going to be like in 4 weeks when I have my final round?

I know I have to do this.  I know I do.  I need to fight to keep the cancer out of my body.  And in the beginning, I thought the sandwich therapy was an awesome idea.  I’d get a break in between the chemo rounds (but radiation was horrible) and I’d cruise through the last three.  Ha.  So much for cruising.

But on the bright side, I’m working through my yarn stash.  I’ve made a scarf and a pair of socks in the past week, and now I’m working on another pair of socks, and then on to some projects that have been sitting around for a while because of my work schedule.

And, I don’t have to fight so much for my short-term disability this time.  When I called to make my claim, I told them I wanted my case assigned to someone who has worked with cancer cases before.  They listened to me, and now I have someone who is working with me.  I’m currently approved through 2/10 – which gives my doctor plenty of time to get the next docs in instead of having my claim suspend on me in the mean time.  And she listens.  Which is awesome.

And, my nephew and his wife out in Colorado sent me a get well present this week – a stuffed Mickey Mouse wearing an Eagles Jersey and a fleece Eagles blanket.  It was so very sweet of them.  The blanket will be laundered and both it and Mickey will be going with me to my final two chemo rounds.

The good with the bad.  The good with the bad will get me through.

Cancer Is Some Expensive Shit

I know I have hinted around here and there about the expenses that I have had to pay this past year for my treatment.  I know I have mentioned that I hit my out of pocket maximum for the 2nd year in a row for our health insurance (two years ago was due to a knee surgery).

But here’s some figures to ponder (these are the charges from the physician – I actually paid $3,000 out of pocket for doctor care last year – my out of pocket max – prescriptions not included):

Cost of my diagnosis – Well, that would include the trip to the rheumatologist who sent me for my spinal MRI, plus the cost of the unnecessary physical therapy, two trips to my gyno, two vaginal ultrasounds, the entire month of mystery disease testing – approximately $5,000.

The Pelvic MRI that sent me on my sprint to the gynecologicial oncologist – approximately $800.

The initial appointment with the gyn-onc – including the every so fun endometrial biopsy (initial diagnosis was hyperplasia) $1500.

Pre-surgical testing – $200

Radical Hysterectomy with a 3 day hospital stay (including surgeon and anesthesiologist fees) – $36,000.  YIKES

Three chemotherapy treatments at $800 each – $2,400.

Nine blood work sessions – $300

Post-surgical CT scan – $750

Consult appointment with Radiation Oncologist – $150

25 sessions of external beam radiation – (hold on to your shorts) – $40,108.

2nd CT Scan – $750.

I still don’t know what my charges for the brachytherapy will be – haven’t gotten my EOB.   I do know that I still have three more chemos and bloodwork to go.

Grand total for 2012 – $88,108 (before insurance).

My cost – $3,000 (plus meds which are billed to my prescription plan – separate from med insurance).

My insurance is great (clearly).  We have a $500 per person deductable, and then once that is done, we have a 90/10 co-insurance (meaning they pay 90%).  When I hit $3,000 (per person) out of pocket, I am not billed for anything else. 

In addition, Bob and I use a Flexible spending account through work – pre-tax dollars are put into an account at the beginning of the year, so I never miss it from my paycheck.  They give me a debit card, which I use to pay those expenses.  This year I elected to put $2,000 in the account.  I know I will have chemo and at least two CT scans this year, plus a colonoscopy.  Believe me, it helps mightily when trying to figure out where income will come from for medical expenses.

Here’s to hoping 2013 is medically cheaper for me.