Tuesday, June 17, 2014

To authorize or not to authorize...that is the (stupid) question!

I knew, once I was diagnosed, that cancer would be hard. And I thought I understood what the upcoming hard things would be.

The very first really hard thing? I couldn’t have imagined it if I’d tried. I had been mammogram-ed, spot-compressed, ultra-sounded and biopsied. I had received the diagnosis in a less than calming way, and had been felt up by two ultrasound technicians, a mammographer, a biopsy doctor, an MRI technician, my female surgeon and my male plastic surgeon. I had little dignity left.

I opted, for several reasons, to have a double mastectomy. I wanted the cancer out, and I didn’t want to find it in another breast another time and repeat the process. And I wanted reconstructive symmetry. So surgery was scheduled on June 13, 2014. (Yes it was a Friday. Friday the 13th...)

On June 10, a nurse called asking me to call the patient advocate at Select Health Insurance as they were taking their own sweet time with the authorization. Remember those words. Patient. Advocate. I called and a woman named Marie answered. I explained my problem. She was unmoved. I told her I was trying to work around my work, FMLA, etc. (I might have begged a little). She asked:“While you were at the doctor did they say you were in imminent danger of losing a limb or your life?” “No” I said, but I thought “I am losing my breasts.” She told me there was nothing she could do but mark it urgent and someone would let me know. Some patient advocate, huh? (I later found out that until my surgeon called, no one had even looked at it!)

On June 11th, my surgeon called and told me that the MRI she’d sent me for a few days prior showed that there was cancer in my right breast as well, that insurance would definitely authorize the procedure and we were good to go. I know it sounds weird, but I was so happy!

On June 12th, we found out that, no, insurance was still not definitely authorized. My surgeon said to show up an hour early for surgery for an ultrasound and biopsy to verify right breast cancer as well as left, and then insurance would no longer be a problem. I had thought that was already the case, but did as I was told. This second ultrasound doctor said he could find no trace of cancer, even though the MRI (more accurate) had found two masses.

Around 12:45 pm on June 13th, I was taken to a pre-op room and prepared for surgery. I had blood drawn and an IV put in (5th try's the charm!). I had been given instructions by the nurse and also by the anesthesiologist. At 3:55 my doctor came in. She said the insurance was still fighting us, stating they had until the 16th (Monday) to decide but that they’d make a one-time exception for her and would ask the nurse committee that decides these things. She'd know by 4:00.

Five minutes later she came back in shaking her head no, and tearing up. She said that because she did not think having two separate surgeries was wise for me with my clotting issues, she advised postponing surgery until the 23rd and in the meantime would schedule an MRI-guided biopsy on Tuesday to prove to the insurance what they should already know.

I was un-IV-ed, dressed, and sent on my way, a little depressed. It’s a hard thing on everyone to gear up for this big a thing, and have the rug pulled out from under our feet at the last second. I know the insurance company had until the 16th, but really that consisted of one more hour on the 13th, and then it would be the 16th. Really insurance people? Really?

It was a rough weekend. I won’t lie. Everyone was crying, stressed out, snappy and slept a lot. By Monday I had come to accept the thing I could not change. At 10:30 a.m. (and without the required biopsy) my surgeon’s nurse called me to say we had authorization. So it took them less than half a business day to authorize what everyone knew they would have to in the end.

And me, and my loved ones are gearing ourselves up again. We’ve had a practice run, so I’m sure we’ll be really good at it this time!

1 comment:

  1. Thank you for writing this! That is so totally amazing! I so wish we could all do without insurance altogether! It has become quite a heartless enterprise, it appears!