Thursday, March 6, 2008

One Win, One Loss and So MUCH Frustration

For 5 months my oncologist and I have been trying to get an MRI and 3 CT scans approved. I was denied by my group insurance plan in November. My doctor appealed only to be denied again. ( One of the experts reviewing my case was a cardiologist - I am not sure why as I did not have cancer of the heart. Another person told me their expert was a pediatrician!) My secondary, independent insurance approved the tests in late December. I felt that my group insurance should pay their portion so I decided to fight it. I started the appeal to the State of California. After I sent my letter and tons of paperwork to the State I worked with my breast surgeon to also help in trying to get the tests approved. After many hours and calls, she was successful in getting the group insurance to pay their portion. They agreed to pay their portion of the $3000.00 part of the MRI but not the $300.00 2d/3d imaging. I was thankful for this - usually my luck would have been that they paid their portion of the $300.00 and I had to pay the $3000.00. The problem was I was approved to have the MRI at one facility by one insurance and another facility for the other insurance. So after many more hours and phone calls I got 2 approvals for one MRI at one location and even got it scheduled for this Friday!! That is my win! When the mail arrived today I received notice that the State and its independent review board has upheld the denial of the group insurance company for my 3 CT scans. That is my loss - although not entirely as my independent insurance plan has approved it so I do not have to completely pay out of pocket. I am still trying to schedule the scans. So almost 6 months to the day that my oncologist wrote the orders for the tests I can now have them. Health Insurance is so frustrating. Now I do not want to sound too much like someone from my homestate, but something really needs to change. For those of you out there that are healthy, get health insurance but really try to read the fine print. Unfortunately I do not think that you really know or find out what they cover until you need it and then it can be too late. I have double insurance coverage we pay over $750.00 a month in premiums and you can see the trouble that I ran into. So hopefully the cancer has not come back for if it has it would have had the chance to quadruple in size over the past 6 months. I pray for clean scans and hopefully less hours per day speaking with doctors' offices and insurance companies so that I can complete more things on " My List".

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