Wednesday, January 14, 2009

Fun with BCBS

Aka BCBS Roulette, aka What Can We Deny Today? You see, this is how it works – the mail comes in, and generally there’s something from some medical establishment or entity. I have to decide at what point I want to open it, and gauge how pissed off it’ll make me. Sometimes I hold the envelope up to my forehead like Karnac the Magnificent, and guess what it is. Hmm, could it be.....another loony adjustment? That’s usually a safe call. So far in addition to the $5000 “adjustment” for the purported “nurse in the room,” there’s also been one for $5K (that one was so alarming I promptly pushed it out of my mind), and then the one that I really love from today, where they said they wouldn’t pay the $3850 for my Oncotype DX test.

What the hell is that? Well, it’s a test done by one single lab in the U.S. only (they’re the ones who developed it), and what it does is give you a score to help you and your doctors determine if you need chemo. Your score correlates with how much you’ll actually benefit from chemo. Low score = less point to doing chemo, which as we all know is a total bitchwhore to deal with, excuse the French.

In my case, my doctors were thinking of putting me on chemo before surgery to see if they could shrink the tumor – and then my score came back low enough that they decided chemo wasn’t necessary. Now, had such a test not existed, we surely would have done chemo before and after surgery, since that’s always been the protocol for cancer in young women, especially with large tumors. Scorched earth, take no prisoners, so to speak. In this case, by NOT doing chemo, we saved BCBS tens of thousands of dollars in chemo treatment costs. And since chemo has a host of potential complications further down the road, that’s more tens of thousands of dollars saved. So potentially over $100K easy.....yet they don’t want to pay for the test.

Needless to say, I will promptly pen a missive to the folks at BCBS to tell them that they can take their $3850 bill and SHOVE IT up their collective asses. And let’s not forget that this is all with someone who has insurance, who’s paid up the wazoo for many years to have good insurance coverage. Not sure why I bothered.

(I would like to note that the company that does the test, Genomics, is wonderful. I spoke to a woman there when the test was first ordered by my oncologist, and she explained the whole thing to me, and said that they would chase after insurance if they denied the claim, and even then if it were still denied, they work with you to figure out payment on a sliding scale. And that’s not rumor – that’s actually how they work. So there are some bright shining lights out there in MedicalLand.)

On a lighter note, today was Kona’s birthday! Or at least I decided it was – since he was a stray, he didn’t exactly have a birthdate, so I figured January 14th would suffice. It’s Old New Year’s, a big party day in the old country, so that’s good enough for me. I tried to put a little party hat on him in celebration – the first 2 times he went to another room and knocked it off – the 3rd time he saw it in my hands and bolted as if I were coming towards him with a hot branding iron. Yeah, that’s the big tough Doberman for you. Anyway, he enjoyed his meatcake (okay, actually a steak), and his pink stuffed bunny, so all was good. Tomorrow we go back to running the usual tight ship around here. Right.

And on a final miraculous note, I, yes I, have actually started training again. Yes, it’s true. I’m moving beyond just striding briskly around the house breathing deeply, and beyond just visualization. I traipsed into VQ last Sunday for my first cycling class, immediately warning Dave Noda that we were likely to see such low power scores as to never have been seen before in the hallowed halls of VQ. 2 hours later, after having generated such a low score as to appear comatose, I can say that I have successfully put Part I of my Art of War plan into place: “appear incompetent and enfeebled so as to fool the enemy.” Onward.

1 comment:

Zappaloosa said...

WORD! Every Day our intrepid Tasha faces a more sinister set of thugs than the garden-variety crack-heads at Tyrone's! Can anyone guess who it is? Yep, the fucking suits at BCBS of Illinois, aka Bureaucratic Crackhead Bull Shit of Illinois. The irony is that I know she has the absolute fucking Golden Cadillac of their policies, and this is how they treat her. After losing my own BCBS health insurance after a brush with a hospital years ago BCBS wouldn't take me back. So, in defiance I went without health insurance for 5 years (ok, no one would insure me) until our friend winds up in the 6% that somehow develop insane breast cancer and I agree to 'come in from the cold' and go get a mammogram (any day now, I swear). But first, I had to go cap-in-hand to the state for insurance. Guess who insures me and my homies in the pool of hideously disfigured and otherwise uninsurable non-humans? Uh huh, my old friends. MY deductable? $5k, that's right, five fucking thousand, not hundred, no cap, and I think that's 5k per procedure, visit, lab test, etc. What do they cover for a premium of close to $400 per month? Not much. MY Plan: Immediately file for divorce and possibly declare bankruptcy. BCBS gives Tasha the bait-and-switch despite her having the Cadillac of policies - what do you think awaits the rest of us, yeah, even you with the insurance through your employer/the state/blah blah? Fools. Don't you see why she doesn't cower when faced with dangerous, ranting, crackheads in an alley? Because she regularly faces the sinister mind-fuck thugs of "Health Insurance" - all the while having to get up and conquer cancer every day. The rest of us are just plain SISSIES. Tasha has earned her own action figure. --Z.