Pinky Pie

No stinkin’ humanity will get between me and my insurance company

Posted on: September 6, 2009

Demand for information that I, of course, have handy

So on and around the date of my discharge from the hospital after my mastectomy surgery for what turned out to be Stage 3A cancer, I received this letter from the insurance company asking me to provide the following information so it can determine whether it will pay for my breast MRI, which found the cancer:

Documentation that the patient is at high risk for breast cancer. This documentation may include one or more of the following:

  • BRCA1 or BRCA2 status (confirmed BRCA1 or BRCA2 mutation or is at high risk BRCA1 or BRCA2 mutation) to include:
  • A list of relatives who have been diagnosed with breast or ovarian cancer, including the age when they were diagnosed. (Need to differentiate whether these relatives are maternal or paternal.)
  • A list of relatives who have been found to have a positive BRCA 1 & 2 gene
  • Whether the patient was premenopausal at onset of breast cancer.
  • Results of risk modeling
  • Age during any chest radiation
  • First-degree relative with one of the following: genetic mutation, Li-Fraumeni syndrome, Cowden or Banayan-Riley Ruvalcaba syndrome.

This list was sent to me from Patient Information Services – not unkindly – but firmly that I needed to provide it as that office did not have the information. Also, I was asked to sign a release of information to the insurance company. I did.

BRACA 1 & 2 are the breast cancer genes that if mutated significantly increase the risk of breast cancer. And Jewish women of Eastern and European descent are at greater risk for having abnormalities in these genes, which I discovered when my doctor suggested we go a step further and I have the MRI because of my ethnicity. (I am not the only Jewish woman who didn’t know this, by the way.)

This insurance demand makes me sick.  I know I had called a day or two before the MRI and was told if I was not to be admitted, that prior authorization was not needed. And the previous mammogram and ultrasound did not find the cancer.

The MRI found the cancer. But that’s not good enough to actually have cancer; I need to prove I am high risk for having the cancer that I already have.

And, really, after a cancer diagnosis and surgery, demanding this information is a little like the proverbial closing of the barn door after the horse (or cow as this is Wisconsin) has gotten out.

Back to the list of questions, my grandmother died of something listed on her death certificate as “lymphosarcoma,” whatever that was at the time. It could have been lymphoma or it could have been lymph node involvement from the breasts. I was age 3 when she died in 1956. My mother had two brothers and I have one brother. BRCA was not tested for decades after my grandmother died and many insurance companies do not pay for that today. I’m not sure if mine does; it might now.

And while I’m ranting, the goal of insurance companies is to delay … delay … delay and hopefully the already ill patient will have died and/or given up on trying to get the coverage. It makes me sick and I don’t need this.

Two years ago when I had interviewed parents for a book about living with childhood cancer, I wrote an essay about how appalled I was that parents of kids with cancer had to struggle every single day to get the care their children needed. My essay, published in the La Crosse Tribune in 2007, referred to our own loss of a child to leukemia in 1986. It began this way:

It’s hard to think of yourself as fortunate when you’ve lost a child to leukemia, but I found myself in that position recently as I interviewed two mothers of children with cancer. How can I possibly feel fortunate? Their children are alive and mine is not.

Twenty-one years ago, I did not have to spend my free time worrying that someone at the other end of the phone – assuming I could get someone on the phone – would decide Matt’s fate on the basis of stockholder profits. The doctor made medical decisions then, not insurance companies.

I also wrote:

Do you want to know what real terrorism is? It’s fearing for your child’s life in the U.S. health system. And, if you think this doesn’t apply to you because you are hard working, you are wrong. We are all one diagnosis – one diagnosis – away from the terror these hard-working mothers live with every day.

If anyone wants the entire essay, I’m happy to share it. But note, I found my diagnosis this summer, a reason I get crazy when I hear things like,  “I don’t want no stinkin’ government getting between me and my doctor.” The insurance company (and how fortunate I am to even have one to fight with) is already standing right smack between me and my doctor.

Clearly, humanity is not between me and my insurance company.

P.S. I have worked my entire life, often seven days a week. My insurance is through my husband’s place of business. If he retires before me how will I get any coverage now that my new name is Pre-Existing Condition.

P.S.S. Public option now! If you don’t want it, don’t choose it. But don’t make that decision for other folks.

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7 Responses to "No stinkin’ humanity will get between me and my insurance company"

oh, bravo for your post and your call to action. I wish we all could stop this absolutely insane debate–why are we even having a debate?–and get on with it so we can free up energy to start solving all the other problems we have yet to deal with.

Thanks for ranting. I have a colleague who had the same difficulty with regard to paying for diagnostic exams when it was suggested that her son was on the autism spectrum. We’ll pay if he has a disorder, but not if her doesn’t?

I would love a copy of your whole essay, you are wonderfully articulate

I suppose now would be the time to confess that in my temping days I worked for an insurance company sending out letters of denial. Apparently I got good enough at it that they transferred me to another division, their investment arm, which I believe was involved in managing the vast sums of money saved in denying insurance claims. This was many moons ago, and I hope I’m older and wiser now and have accomplished enough good in my life to counteract those acts of complicity. The best possible outcome for them comes when you do not question, do not pursue, do not demand your rights as an insured. So — good on you, and continue hold them accountable for your care – all of it!

Mary

Take that Obama communist-accusers…

Thank you for this “rant” which I more accurately classify as speaking the truth. Someone who’s there, been there and wants to be done with that is the best possible voice of reason for this issue.

The idea that your situation was better 21 years ago when your child did not survive than parents today whose children have… I would love to see the look in a Senator’s eye if you said that face to face… or a CEO of the insurance company. Exactly how do certain people sleep at night?

Anyway, thanks again for sharing this.

Thank you. Exactly. If you don’t want, don’t choose it, but don’t make that choice for other people.

Thank you.

You go girl!!!

I think we should have term limits on all our members of Congress and the Senate and when they move on to a new job they lose their current (publicly funded) insurance. Maybe that dose of reality would make them think twice about how they vote for health care reform.

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