Insurance Drama

Holy F*CK WARRIORS. What an insane and stressful morning. Kevin (my oncology therapist) said that cancer is a roller coaster of emotions and boy is that true today!

Healthy Habits Morning

I woke up and actually did a healthy habits day! That’s when I do physical therapy, meditate, journal and work out. I did 20 minutes on the elliptical for the first time since this whole thing started!!! All my biopsies and surgeries had put some restrictions on what I could do so it cheered me up a bit to be able to do something so important to me again but I was still feeling a little blue from Monday and Tuesday and had started a blog post about that when my phone rang. It was Nurse Stacey with bad news.

My Health Insurance Status

Basically, the deal is I have short term medical insurance. Because it’s “short term medical,” it does not have to meet Affordable Care Act guidelines and pre-existing conditions can be a reason to deny a claim. We had chosen this insurance because it was thousands of dollars cheaper a year in monthly premium costs and we have no pre-existing conditions. Now that I have breast cancer and am making huge claims, our insurance is investigating me to ensure I did not have breast cancer in the last three years and I did not have a doctor who led me down the wrong path. If they find reasons to believe I had one of those things, they will deny all of my claims for the breast cancer diagnosis and treatment. This process is separate from prior authorization and can take up to a year to determine if they will or will not pay, which nobody knew the process could take so long until this morning.

Possible Chemo at Bergan

So I was writing my blog post recap of the last two days when Nurse Stacey calls to tell me that they do not have approval to do my chemo at Methodist and I need to go to the Nebraska Cancer Specialists (NCS) clinic at Bergan to have it done, because Bergan has more resources for under-insured or uninsured patients to get chemo (in case my insurance does not pay for anything). I was gutted. This would be a whole new prior authorization. More waiting. More time for my cancer to grow. More money out of our pocket. More stress. I just couldn’t take it anymore.

Waiting For Up to A Year!

I came to the bedroom and just sobbed. I didn’t know what to do. Nobody knew at this point how long the investigation process could take. I decided to call my health insurance’s investigation center and ask. This is when I’m told up to a year. A YEAR FOR A CANCER PATIENT TO GET APPROVAL OR DENIAL! That’s life or death! That’s when I sort of lost it and started posting on Facebook. Sharing our GoFundMe again. Sharing our Amazon Wish List again. Trying to figure out where we can save money so that I can get treatment.

I let Nurse Stacey know about this new information too. At this point I’m not sure what to do. Nurse Stacey wasn’t sure what to do. I was just blowing up those closest to me and trying to get a plan in place. There was no telling when Bergan could get me in for chemo. I was a mess. Every time I’d try to jump in the shower the phone would ring with new information. I literally couldn’t even do anything or even attempt to calm down. The phone just kept ringing from Stacey, from insurance, and from insurance investigation people. It was a lot.

Possible Chemo at Methodist

Finally on my fourth attempt at a shower Nurse Stacey calls me back again. She says “we’re doing chemo tomorrow at 11AM at Methodist!” I was floored and overjoyed. Now I had tears of joy streaming down my face. “HOW??” I half-scream cried at her. She said that after talking to basically every department head there is, NCS decided that since science is really slow and hasn’t come up with a new chemo drug, the chemo itself won’t be too overly expensive; it’s the cost of pre-medication and the Neulasta that are expensive, but NCS has grants and funding in place to help off-set those costs. So even if insurance comes back on some next-level bullsh*t and denies everything, NCS is going to help us get the cost down as much as possible to be able to pay for everything over the course of a few years if we have to. It’s not ideal, but it allows me to start treatment to, you know, SURVIVE. Stacey and the team at NCS are already working on getting us into some programs through the drug companies directly to get reduced costs on those expensive meds too.

Insurance Won’t Cover Chemo

This was around noon and I thought I was in the all clear for tomorrow, but obviously still nervous. NCS still wanted to receive the authorization prior to starting chemo. I was seriously beat and decided to take a nap. At 3:30 pm I woke up and shortly after received a phone call from my insurance case manager: they will not approve one of my chemo drugs, the doxorubicin, because “it’s an off-label use of the drug.” Which makes zero sense, because it’s one of the oldest chemo drugs around and one of the few to treat breast cancer. Since insurance won’t approve this medication, the whole treatment plan for chemotherapy is denied. So no chemo tomorrow. We are back to not knowing when chemo will start or where.

Thank You Stacey & NCS

I simply can not say enough good things about Stacey and the team. While this is all scary and we may not even know for sure until next year what is covered, she has and continues to do everything possible to get my treatment started. Even my insurance case manager is super impressed with her and the team. I am so grateful I went with Nebraska cancer specialist.

So Here We Are

That’s where I”m at right now. I won’t really be able to settle down until the poison is in my body fighting off the cancer. Right now all I can do is get out and enjoy this beautiful day. Do some peaceful reorganization later and ask for your help. Please continue to keep me in your spiritual journeys. If you can check out the updated Amazon Wish List or donate to the GoFundMe. Share them to everyone you know. Save anything you have of value that you were going to give away for our upcoming summer garage sale to help me raise funds this summer. But most of wall dear warriors, go have a magical day and create some magical moments for someone. <3