As the Road Turns

More insurance coverage twists and turns


For a while it looked like we were getting nowhere. A few representatives from our insurance company said there was nothing they could do. A representative for the University Hospital exhausted all her attempts to help us. And a representative for the pathologists group informed us that regulations do not allow them to give us any breaks. There was still one more representative for the Hospital who did not completely give up, but his effort to get a higher-level involvement from the insurance company did not successfully connect us.


Then, the representative from the pathologists group called. It turned out his group could reprocess the claims through the insurance company in a way that would not require us to pay. The reasons he gave, relating to the insurance company hated the fact that they would end up paying more for the same treatments when their group went independent, and relating to the group of doctors should be considered providing services through the Hospital when the work is thus rendered, were somewhat opaque to us. I wonder whether the email I sent to a widely-followed blog the night before added some oblique push for a different resolution (I never got any follow up to the email).


In the mean time, I’ve already had my latest blood test done in an outside lab. The upside is that I’m pretty sure (now how much is that worth?) that I would not be asked to pay more than a predetermined co-pay. The downsides are a few.


First, when I went to get my blood drawn, the person could not understand the prescription. Not that it is hard to read, I assure you, as it is written in one of the neatest handwritings I’ve seen. It’s the acronym of the oncogene that is too hard to decipher, even after a phone call to someone she trusts. I was glad that I know this stuff, and explained to her the gist of BCR-ABL in two minutes. Equipped with the info about chromosome 9-22 translocation, the code for the blood test was eventually found, after another phone call.


Then, one day before my scheduled visit to see my oncologist earlier this week, we found that the test results were not yet available. The visit was then rescheduled to a week later, for the 16th of September.


Unfortunately, serendipity has it that September 16th is a day on the other side of a virtual line in the sand along the river of time, where we could get into insurance coverage trouble yet again in another saga.


A couple of months ago, our insurance company sent us a letter notifying us that its contract with the University Hospital was likely to lapse, and any treatment we get from the hospital may be billed as out-of-network. When we called, the university’s representative was very adamant: they strongly believed that the contract would be renewed in time, and they believe the insurance company sent the letters solely to cause fear and uncertainty in the community, and to apply extra pressure to the contract negotiation process.


Alas, the contract was not renewed in time, and when we called before my previously scheduled doctor’s visit, we were told by the hospital that a temporary contract was in force for the time being, until September 15th.


So now we are uncertain on two fronts: we don’t know whether the doctor will be getting the correct test results in time, and we don’t know if we see our doctor on the 16th our visit will be covered by the insurance plan.


Would anything in the healthcare reform plans being discussed help our situation?

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