Tuesday, January 17, 2006

My New Part-time Job

We have already established that being a cancer patient is a fairly time-consuming affair, what with all of the schlepping to and from the seemingly endless array of doctor's appointments, tests, and procedures. We have also established that I generally (MUGA scans aside) tend to view this with bemusement, as if I just happen to have a very active social life (populated primarily by medical professionals).

But I do not share this same bemused perspective when it comes to what I can only term "the business of cancer," by which I mean all of the paperwork, phone calls, and other mind-numbing administrative torture one must endure in order to A) obtain health care and B) not go bankrupt as a result.

Yes, I had to deal with this the last time around. And yes, I do have some nightmare stories from four years ago. But back then, I had professional help (and not of the psychiatric kind). Back then, I had a friend, colleague, and all-around miracle worker named Dawn A) whose job it was to intercede on my behalf with my insurance company and B) who did her job, usually unasked, with unerring grace, efficiency, and sensitivity.

This time around, I am insured by two different companies—one through Columbia, and the other through Zach (and the Screen Actors Guild). The two plans are completely different—for example, one requires referrals, the other doesn't. Some of my doctors participate in one plan, some participate in the other, and some participate in both. I have yet to figure out how "coordination of benefits" is supposed to work. And the one that requires referrals provides conflicting information to me (the patient) and to the providers (my doctors) about what kind of referrals I need. After I was assured that I did not need a separate referral for the MUGA scan, I received a statement saying that St. Vincent's could bill me $4,000 for the procedure because I didn't have a referral. This is the same procedure that I need to have every three months for the next year, so you can imagine how eager I am to get this straightened out.

Aside from inane insurance issues, I am also dealing with the HIPAA-induced tedium of collecting my medical records from various doctors and labs so that other doctors and labs can review them so that we can resolve the question of whether I will be having another course of radiation treatment.

I had planned to spend today working on my J-school master's project. Here are some of the things I did instead:
  • Called the social worker extraordinaire at Mt. Sinai's Breast Health Resource Program to get a referral for a physical therapist/lymphedema prevention specialist.

  • Called my fantabulous surgeon to confirm that I could start physical therapy and, assuming I could, to request a prescription.

  • Stayed off the phone so that the prescription could be faxed to me.

  • Called and left a message for the physical therapist.

  • Received a return call from the physical therapist and gave him some background information.

  • Faxed the prescription and my insurance information to the physical therapist.

  • Fielded three additional calls from the physical therapist's office—two about my insurance coverage and one about scheduling my appointments (twice a week, starting next Thursday).

  • Called the place where I was fitted for my lymphedema sleeve and made an appointment to pick it up on Friday.

  • Fielded a call from my radiation oncologist's office at Mt. Sinai asking that I sign a release form to obtain some of my records from St. Vincent's (specifically, the films of my pre-biopsy sonogram and a CD-ROM of my PET/CT scan).

  • Stayed off the phone so that the release form could be faxed to me.

  • Filled out the release form and faxed it to St. Vincent's.

  • Called my oncologist's office at St. Vincent's to find out how to obtain the pathology slides from my biopsy, which I need to deliver to a different radiation oncologist (the one providing a second opinion) by Friday.

  • Fielded a return call from my oncologist's office.

  • Called Zach twice with instructions on where to go to pick up the films, CD-ROM, and pathology slides.

  • Called the other radiation oncologist's office and confirmed that the other records I need to gather (aside from the pathology slides) could be delivered later on (my appointment is not for another two weeks).

  • Left a message for the IVF nurse we are working with to find out what we are supposed to do next.

  • Left a message for one of the J-school deans, asking for the name of someone at Columbia who could, à la Dawn, help me deal with the university's insurance company.

  • Fielded a return call from the J-school dean, who gave me the name and number of Columbia's insurance guru.

  • Left a message for the insurance guru.

  • Fielded a return call from the insurance guru, told her about the $4,000 MUGA scan bill, and gave her other necessary background information so that she could follow up with the insurance company.

  • Fielded a return call from the IVF nurse and confirmed our next step.

Still to do:
  • Arrange to pick up my old mammogram films from my radiologist's office.

  • Arrange to pick up my breast MRI films from a different radiology office.

  • Deliver the sonogram films and CD-ROM from St. Vincent's to Mt. Sinai.

  • Deliver everything else to the radiation oncologist who is providing me with a second opinion.

  • Schedule two other doctor's appointments.

  • Follow up with Columbia's insurance guru, especially because today's mail brought a new statement saying that I am responsible for another $2,335.05 because—you guessed it—I didn't obtain referrals that I was told I didn't need.

And this is all with health insurance. The mind boggles.


Anonymous Anonymous said...

Now in CA, an oral referral is OK, which has simplified things immensely. Too bad NY doesn't have a similar law. How about another part-time job as legislative advocate? Kris

January 18, 2006 5:46 AM  
Anonymous Liz m from Oakland ca said...

About a month ago, in response to all this I would have said: healthcare reform! socialized medicine! centralized healthcare within the federal government is the only way to get out of this morass! But since the first of the year, and the tales of woe of all the medicare recipients who are now paying up the wazoo for prescriptions they're supposed to be covered for and many of whom are therefore not taking their medicines because they can't afford them, I say now we're really in a pickle. A healthcare guru in every home just may be the only way out of this mess....


January 18, 2006 4:44 PM  
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