Friday, February 17, 2017

Insurance Fiasco and Near Meltdown

Today is Friday, February 17, 2017 and  it's been a rough week, folks!


Today I can finally take a deep breath and relax. Today is the first day in a week that I didn't wake up exhausted from tossing and turning all night. Today was a good day!

My brain has not stopped working overtime since they found that lump a month ago tomorrow, but at least it was on a low hum. This week, I feel like one of those memes about having too many browser windows open!

It all started last Thursday.  My surgery date had been set the day before for Monday, March 6, 2017. We had a plan! Yes!
Thursday, I was off of work and happily fiddling around the house, working in my craft room on a project, etc.  That's when the first call came....the Plastics office had verified my insurance benefits and said: "I'm pretty sure you were not aware of this before you came here, but we are OUT OF NETWORK with your specific plan."  

My brain didn't seem to be processing.  I was thinking:  What??!!??  That's not even possible.  The Breast Center referred me along with my Surgical Oncologist. The Breast Center that is affiliated with the hospital I work in!  Not possible.

Turns out she was surprised too--having never had this happen with one of our employees in the past.  But, she was obligated to tell me what she had been told.  I was confident this was an error and let her know that I'd check into it.  I immediately contacted my Breast Center Navigator....who was equally shocked and also started looking into it.  There were lots of long phone calls Thursday and Friday between me and my insurance carrier, me and the Plastics office, me and my bosses, me and my family, etc.  No one could figure out the problem, but everyone felt sure it was an error. Both evenings, my insurance carrier assured me that it was a mistake and that they would let the provider know.  And, the next morning, I'd receive a message from the Plastics office that it was not an error.  

I had to work Saturday and Sunday, but I still received emails from the Plastics office manager and some of the folks I had contacted to try to figure the mess out.  It was a fairly sleepless weekend.  

I knew that everything was in God's hands and I had faith that there was a reason for this stressful situation even though I could not see what it was.  But, it was not easy. My mind raced with thoughts...what would I do?  How could I possibly afford this?  I can't afford this...so now what?  This is the only group of surgeons in the area that do this procedure...ugh.  Do I really have to consider a lesser surgery because I can't afford the one I felt confident I needed?  It was all so smooth, why now, Lord? 

On Monday, I was off of work and waiting to hear some good news....instead, the Plastics office informed me that they could not hold my surgery date while we tried to remedy this.  She told me that she would still be trying to help me, but the date would NOT be held.  This was quite a blow!  I felt like the wind just went out of my sails.  I was clinging to that date...that date meant we had an active plan...that date was hope. And, just like that 

it was gone. I nearly cried right then.  I came close several times this past week.

I reached out to everyone I knew who might be able to help.  And, it turns out it was a good thing I did because it was a much bigger confusing mess than anticipated and it had the potential to affect other employees trying to access benefits.  A couple more days and still no closer to a resolution.  Finally, I reached out on Thursday morning (afraid of going into another weekend) to my administrators.  I let them know how nervous I was getting about this rocking on.  Everyone I knew was praying. And, that morning, the absolute right contact from our corporate benefits called me!  Not only was he a sympathetic and kind man, he instilled confidence immediately. He was finally able to identify where the issue started and address it.  He was so very nice keeping me updated all day on his progress.  By 6pm, as my shift was winding down, I got the final word that it was fixed!  And, not only for me, but addressed with the carrier so that no one else should run into the same issue.

The Plastics office manager called me within 15 minutes and confirmed that my benefits were exactly as I had believed all along and that they could reschedule me!!  My original date had been given away, but just that same afternoon she had cancelled.  My Surgical Oncologist was still holding the date for me, so this morning, I had confirmation from both offices that I was back on the surgery board for March 6th!!  Praise the Lord! Prayers were answered.

All this week, I questioned the reason this was happening to me.  Why everything had fallen so easily in place just to have this horrible, stressful, scary week.  My mother commented that Satan was trying to shake me because I have been so good with all of this.  Nothing has gotten me down until now so he hit me with a big area of concern...finances.  Maybe.  

Maybe, it happened to me so that it wouldn't happen to someone else....someone else whose cancer is more invasive and a delay would have been scarier....someone else who didn't do medical billing in a past job like I did and might not have understood that this wasn't right and questioned it....someone else who needed the stress even less than I did. 



From: https://www.flickr.com/photos/brizo_the_scot/4013939756
It doesn't really matter why it happened. What matters is getting through it...lessons learned. 

You might not face insurance worries, but you are likely to hit some kind of roadblock on this journey....your flock of sheep in the road.  It might be finances, or your significant other getting time off work, or a family vacation that has to be cancelled or a 
hundred other things that throw you for a loop. Just know that you can get through it....or maybe you will have to detour around it....but you will get to the other side if you keep moving, keep pushing, keep going.

I got through my scary bump....or LUMP...in the road this week and I slept better last night than I have all month!  And, tonight, I spent enjoying a night out with my son.

This is quite the journey. I'm learning things I never really wanted to learn. But, say it with me:  
God is good ALL the time!  
And, ALL THE TIME, God IS good!





3 comments:

  1. God is good ALL the time! and, ALL THE TIME,God Is good! I am so thankful you are on target again. Let's beat this thing. Then plan a trip to the ocean. The waves the surf, the sunshine.

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  2. I am going through the appeal process with my insurance right now. They are denying a prophylactic mastectomy of my left breast. I am currently recovering from a mastectomy of my right breast. First diagnosis was in 2000. It was stage 2 Er+ IDC. I had a lumpectomy and bilateral reduction, chemo, and radiation. This past Jan. I discovered a lump and it is being considered a new occurrence. Both in my right breast. Because I am BRCA - my insurance doesn’t consider me high risk. I just don’t want to worry anymore. I didn’t want to delay getting rid of the cancerous breast, so I had the mx of my right breast and am waiting to go through the appeals process before I have reconstruction. I am planning on having a DIEP flap. I am trying to see where God is working in all of this, and trying to trust that the right decision will be made even if it isn’t the decision I want.

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    1. I’m so sorry you are going thru this. Waited no and not knowing is the worst. And, I totally understand your desire to just get it done! As hard as it is, God knows the right answer and He will get you through. Prayers for you during this frustrating time.

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