Wednesday, July 25, 2012

I Guess I am the Boss of Me

In between my thyroid cancer diagnosis and subsequent surgery, I began to work on getting a new oncologist for my WM. I mentioned in this post that in May 2010 I met a doctor who is a world class expert on my disease. I'm covered by my husband's insurance and the type we had chosen did not consider this doctor's clinic to be "in network." In November 2010 we looked into the other options and found that there was an option at his work that did, indeed, cover it as in network. Hurray! All we had to do was choose that option at open enrollment and move on.


I called in November 2010 to find out if I would be able to get an appt with this doctor  in 2011, and what the process would be. I spoke with a Patient Care Coordinator and told her I am on watch and wait, that I have an oncologist in Everett. I named the doctor we wished to see, but explained our current insurance did not cover him. Therefore, I was interested in coming in after our new insurance became effective in 2011.
I was told he has limited appts for new patients and that before I could make an appointment they needed my MR, so we should get started now. I was able to collect and mail the records and received a vmail from the care coordinator wanting to schedule an appt. When I called back, I left a vmail, then sent her an email. I explained that I was having my thyroid removed on Dec 29 and I have multiple post-op appts in January plus radioactive iodine treatment. I said that I would be available after that, but I realized that I might have to wait to see this particular MD and that was okay.
She scheduled me for an appt on January 24 anyway. At the time she mentioned that before the appt she would order slides so they could confirm the diagnosis. At no time did she mention anything about a charge for this; I suppose it shows my ignorance but even if I had known there would be a fee, my entire interaction with the care coordinator was prefaced with and based on the fact that my insurance would not cover SCCA until 2011. I cannot fathom why they would provide services in 2010 for an appt at the end of January 2011 knowing that I do not have insurance coverage but will have it in 10 days.
I received the appointment packet and I read each attachment in detail and discovered that the reading of the slides could cost as much as $3000. I called first thing in the morning. I began the call asking if she remembered me, I was the patient whose insurance wouldn’t cover the charges till 2011. She did, and even remember my husband's employer.  So, I explained that I was concerned that language in the enrollment package regarding the charge for the slides.
Her immediate reply was, “we’d better make sure that those slides don’t get read till January.” I said absolutely not because, as you know, I do not have insurance coverage till 2011, and now I’m so concerned that I want to have everything pre-authorized. She put me on hold, came back and said that I should speak with her supervisor.
The supervisor said that the slides would not be ordered until the appt was confirmed. I reminded him that I have an appt scheduled and have received the packet. He looked me up and found the slides had been ordered. He said he would immediately halt any services-if not already performed-and call me back.
We spent the rest of the day in phone tag; I called him back around 11:30  and left a vmail. He called me around 1:30 and said he was still checking. Finally, he called around 4pm and said the slides had been read. He said that he had submitted a request to the “quality committee” and recommended that I not be held responsible for these charges. He said the committee doesn’t meet till middle of next month and that I would hear after that.
Long story short (well, not really), I was not charged for these services and I've been extremely happy with the clinic and the doctor ever since. However, it illustrates two important points: 
  • when you have a chronic illness, the administration of it is a part time job. 
  • you must be your own advocate and not trust the system to take care of you
Scripture referenceRomans 12:17-19

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