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Meaning of life

"The meaning of life is to find your gift. The purpose of life is to give it away." ~ Pablo Picasso

Thursday, May 28, 2009

The Cancer Chronicles 36

IF IT'S MEDICALLY NECESSARY

I must be feeling better, because I’m going to bitch today. If you don’t want to hear it, click the little red "X" in the upper right hand corner and "POOF" you’re back to your happy place. Enough attitude for ya?

I have a friend who blogs about life with cancer and her trials and tribulations dealing with it. A recent topic on Jeanne’s site, The Assertive Cancer Patient discussed PET Scans and the fact that her doctor told her Medicare would only pay for ONE PET scan a year. This worried me because in June my doctor has scheduled me for 2 CT scans and 2 MRI’s and I was concerned that Medicare might not pay for all of them.

Typically, I would only have the 2 CT Scans, but due to some recent problems in my lower back the doctor was concerned and ordered and scheduled the MRI’s in addition.
I'm worried that the cancer might have traveled to the bone.

When I was in my 30’s I fell off a two story roof and compressed two lower vertebrae. The emergency room doctor told me that I would have a lot of pain as I got older because of this. Until the last few months I had very little problem, but lately the pain has been sever. During the last three weeks, I also have had great pain in my right elbow.

I can’t recall if I bumped it. Perhaps I’ve slept on it wrong. I just can’t figure out why it’s taking so long to heal. Because of all this I can’t help but wonder if the cancer has metastasized into other areas of my body. So, I deferred to my doctor with these issues and he ordered the extra scans. After reading Jeanne’s blog I emailed MD Anderson’s business office to ask if they would get pre-approval for all the work being done, just to be safe. The last thing I need is more huge medical bills!

EMAIL TO MDA BUSINESS OFFICE:

Who do I contact to make sure the tests I am scheduled for in June are covered by my insurance?

I'm having CT scans and MRI's. I know the x-rays and blood work are covered, but wasn't sure if there was coverage or a limitation on how often the CT and MRI's can be done.

Thank you,

REPLY:

I will need for you to re-verify that the ordering physician needs both the CT of the head and neck and the MRI of the t spine and l spine. These are a lot of scans (4) and the insurance will surely have a problem allowing so many to be done. If the physician does not need all these done the physicians scheduler needs to cancel the ones that are not needed and if the physician does indeed want the above done than I will try to get the authorization. Please check with me prior to 06/18/09 to verify which scans got approved. Call me at 713-745-XXXX

Thanks!
Roberta XXXXX

**************************************

I then left a message with my doctor’s office to “re-verify” that he needed all the scans. I read the email from Roberta so the doctor would understand the issue. While waiting for a reply I contacted Medicare and felt like I was chasing my tail!!!

CALL TO MEDICARE:

In the next couple of weeks my doctor has scheduled me for 4 scans, 2 CT Scans and 2 MRI's. Is all this covered by Medicare?

The answer was vague:


“IF IT’S MEDICALLY NECESSARY, Medicare will cover it."

Hum, who decides if it's medically necessary?


"MEDICARE."

So do I need to get prior approval?


"NO."

So, do I go ahead and have all 4 scans done? I don't want to end up with a big bill that I can't pay.


"IF IT'S MEDICALLY NECESSARY."

OK, so I don't need prior approval and I have the scans done that my doctor thinks are "medically necessary" and Medicare determines that they are not "medically necessary" and I get a bill for what's not covered?

"YES, YOU COULD BE BILLED."

CLICK!

My doctor’s nurse, Ann, returned my call and I told her the situation and that the business office needs “re-verification” that the scans are needed and that the insurance company would surely have a problem with them. Ann tells me that I should not have to worry and that it is the business office’s job to verify any needed approvals. Roberta told Ann she never told me to “re-verify” the need for the scans and denied stating, “The insurance company would surely have a problem with them.” She lied! Ann called here out and said she had a copy of my email and ended with, “I know you will take care of this, right?”

WTF? Roberta outright lied! I really appreciate Ann for her honesty and kindness. As for Roberta…find another job, you don’t belong in a field that requires you to care for the ill!
Guess who’s not “medically necessary!!??”

I called up my dear friend Deborah to bitch and complain. As I’ve often I complained, “I’m so tired of all this. I’m ready to die. Why doesn’t God want me?”

Without a beat, in a very Groucho Marks tone she quipped, “Ya want a list?” Love ya Deb!

That’s all for today folks!

Peace
B

1 comment:

Maureen said...

I deal with insurance companies all day at work. I think they play fricking games hoping you will just give up and pay out of pocket so they don't have to. You would think that they know you are sick and the last thing you want to deal with is fighting with them and wasting your energy trying to wade thru their rhetoric. Hang in there. {{hugs}}

Words To Live By:

"The best way to find yourself is to lose yourself in the service to others." -Mahatma Gandhi