Pinky Pie

Waiting for the governor & Me (revised with other posts from the day)

Posted on: January 21, 2010

Think black and white movie in the 1950s. The condemned is pacing in his cell, waiting for word from the governor that he (usually he in the 1950s not she) has gotten a reprieve from the gallows. Will it come in time?

Who is this person? Look in the mirror. It could be you.

This morning. I am waiting for the governor.

It is 6 a.m. as I start to write this and my appointment for the radiation simulation is at 9 a.m. No word from the governor – the insurance company – about whether it will allow me to have this appointment today.

To be accurate, I could go to the radiation simulation appointment no matter what – if I’m willing to pay the difference between in network and out of network costs out of pocket. Could you? With an estimated $51,000 for the radiation service for my breast cancer, it would mean taking on another $15,000 or so in debt in addition to the deductible and co-pay for 2010 for myself and my husband. And that would be on top of the of the deductible and co-pay for 2009 that we are still paying for.

Or I could go to where my new insurance company now would refer us – Eau Claire, Wisconsin, two hours away or Appleton, Wisconsin, four hours away. That’s two or four hours each way and radiation is going to be five days a week for nearly seven weeks.

With radiation causing increasing fatigue over the seven weeks, I certainly could not drive back and forth each day. Staying in a motel, isolated from everyone I know each week, doesn’t seem like a good alternative considering the treatment itself takes about 10 minutes each day.

Would that care in Eau Claire or Appleton be any better than what we have in La Crosse? No. We have a Mayo Clinic radiation oncologist just down the hall in the cancer center at Franciscan Skemp Cancer Center where I received my chemotherapy. But he is out of network. His service also has a 99 percent approval rate from patient surveys.

My insurance is apparently cheaper for my husband’s employer because it will not allow referrals to Mayo Rochester. Yes, Franciscan Skemp is part of the Mayo Health System, but it is not Mayo Rochester. Does that make sense? No. And guess what. If they turn me down for La Crosse, I’ll have to start over in Eau Claire or Appleton. That will mean a new consultation, etc. And time is ticking away.

I need this treatment before any remaining cancer cells that survived chemotherapy have a chance to reorganize.

Radiation simulation is the appointment just before radiation itself. This is the time when the radiation oncologist figures out where to aim – and we want him to please aim well. He also figures out the size of the dose and to top it off I get little dots tattooed permanently into my skin as a target. They’ll also be a permanent reminder of this cancer.

Lucky me.

I should be so lucky. My life is literally in the hands of the insurance company.

But think it couldn’t happen to you? I thought it couldn’t happen to me. My husband and I have worked all our lives.

I’ll keep you posted.

Post 2 of the day: Approved & Me!

Just got a call from Julie at Cancer Support Services of my insurance company. Word of the reprieve from “the governor” came 40 minutes before my appointment.

I have been approved for radiation therapy at Franciscan Skemp in La Crosse and, if I need it, to have additional referrals to Mayo Rochester. (I don’t want that, obviously, because I want everything to go well.)

Read the previous blog post or two to understand why this is a big issue.

It’s still about more than me. What if I were ten or fifteen years older, did not have computer savvy, or not enough gumption to write my own letter to request the service and to keep calling?

Post 3 of the day: Approved & Me, but …

I need a “gap exception” number before Franciscan Skemp will provide the service today. I had a “reference number,” but that is not the same. The fear is that I would not be covered otherwise for today. So as the minutes tick by until my appointment, I’m still trying to get the gap exception number. Sigh. And Care Coordination for the insurance company tells me that is the right number for the gap exception. Read the previous entries to understand this. And then explain it to me.

Added Post 4 of the day: I’ve been simulated & Me

Or was that assimilated? Wait, that came years ago.

Seriously, I had the simulation and have the “gap exception” that allows me to have radiation therapy treatment in La Crosse. I am grateful, astonished at the cost, and still amazed by all the hoops – including last minute hoops – that had to be done.

But I had the simulation this morning, I’ve been tattooed with target dots and will begin the actual treatment next Wednesday.

How did insurance approval finally come through? Beats me. It, of course, makes sense that I have the treatment in La Crosse. It required a doctor to approve the “gap exception” since the only radiation oncology department is out of network.

I had other help. At acupuncture on Tuesday, Sister Eileen McKenzie, the acupuncturist, said she would get the nuns on it. She told me that no insurance company can withstand the prayers of 200 nuns.

Evidently not. I’m joining the convent just as soon as I finish my radiation therapy.


1 Response to "Waiting for the governor & Me (revised with other posts from the day)"

Wow! I hope you get this straightened out.

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