24 February 2010

Oh! But They Wanted Someone Else to Drive!

On the eve of my first office visit with Dr. T, to find out what cancer I had and the appropriate treatment regimen thereof, a claims representative from my health insurance company gave a call. She was calling to inform me that Dr. T was not an approved oncologist on my POS network, although he is listed in the PPO network -- which I did not have! Therefore, the insurance company would not approve any treatment I would receive from Dr. T.


After taking a deep breath and counting to 10, I reasoned with her, telling her that I had no choice in the matter. The Internist assigned to manage my care at the hospital picked Dr. T to be my oncologist. Presumably, the hospital had cleared Dr. T with the insurance company before he met with me. And because of that, I went ahead and consulted with him and subsequently decided (with great relief) that he was the man for the job.

The claims representative apparently heard none of what I just said. Her robotic reply to my impassioned plea for Dr. T was "I'm sorry mam, he's not in network. So you're gonna have to pick one who is. There are plenty of good choices on there." Just like that? "Choices?" Just pick another oncologist from the list? Would this be just like picking a lunch special from a deli sandwich board? Or a new lipstick shade at a cosmetic counter? Choices? I mean, some people even have a hard time picking a new hairstylist, nevermind someone who's going to save their life! Just pick another oncologist from the list?

How would I do that? How would I start over again? How would I tear myself away from Dr. T, to whom I had just entrusted my life, and go on to interview a new group of oncologists? I couldn't fathom it! Dr. T was the first doctor who had steadied me since my ordeal began. And now, they've gone and pulled that very foundation from underneath my sanity. How would I interview a whole new group of oncologists, when deep in my being I knew I had found mine? My brain was in shambles once more. I had that crazy-scary ride feeling again! And I was panicked because time was of the essence. Cancer was eating away at me and they wanted me to go back to first base again. Did she not read the file and notice that I had Stage 4 cancer? What in the world were these people thinking? Or were they?

Over and over, I insisted that I could not change oncologists mid-stream. Dr. T. was well on his way to diagnosing my cancer and coming up with the treatment regimen. "OK," the rep said. "I'm afraid that if you insist on an out-of-network specialist, you'll be liable for a $5,000 deductible. And then, we will only pay for 80% of your medical costs."

[Thanks very much for your kind generosity, oh mighty insurance company! How about I reciprocate that with not paying premiums up to $5,000 and then pay only 80% of my premiums thereafter? Fair?]

I'm a single mother who works for a non-profit organization. Non-profit workers do not make a lot of money. But hey, it's a lifestyle choice and I don't expect anyone to feel sorry for me. I'm glad to be working for a cause and away from the corporate grind. But since the pay is not high, financial sacrifices are made. One of them is paying over $200 a month for my health care insurance because I wanted to be prepared for times such as these. Even though these premiums (among other living costs) made it difficult to make ends meet every month, they were necessary costs. So, to be liable for a $5,000 deductible plus 20% of what would be a huge medical cost was a something I couldn't do. No way! I don't have a mortgage against which to borrow nor any other assets to throw into this looming debt. I am a member of a the growing class of the working poor.

Desperately, I appealed to the better side of the claims representative and "begged, pleaded, borrowed." I did everything but walk on bended knees to the insurance headquarters whilst flogging my back raw to present them my first-born. But to no avail. She said rules were rules. Either I pay out of pocket for Dr. T or pick another oncologist from the list.


Now what?

[Mine was a minor situation of the millions of other more egregious reasons why we need Health Care Reform. Health insurance companies cannot be keep preying on the weak and the sick and keep gouging their insureds. They have to be regulated! This abuse cannot continue. I am but a mere drop in the bucket. Sadly, health insurance does not ensure health care.]


WhiteStone said...

Oh, Wow, I think I would have succumbed on the spot! Now I can't wait to read what happened next in your fight with this Cancer Beast.

Daria said...

That is crazy ... just my opinion.

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