Frustration

As I’ve said many times, patients have to be their own advocates or, if they are unable, someone they trust must do it for them. This applies not only to the actual medical care but also to such matters as insurance coverage. Here’s a case in point.

I have made the decision to have the catheter implanted so I can drain the fluid myself. For those who are interested it’s known as a Pleurx catheter. Pleurx is the brand name. After it is implanted each drainage requires the use of a Pleurx drainage kit consisting of a drainage bottle, 3 alcohol pads, a clamp, a cap for the valve, some gauze pads and a foam pad. A case of 10 of these kits costs about $750. You gotta love it. Based on my rate of fluid accumulation I would need about 8 of these per week costing $600 per week.

Before going ahead with the procedure I wanted to make sure my insurance would cover it. I looked into it several weeks ago by calling the insurance company and was told that it is covered but that pre-authorization is required. On Thursday the hospital called and wanted to schedule the procedure for tomorrow. I told the woman that was fine with me as long as she was able to obtain the pre-authorization. She felt she would have it by today so she scheduled it. Over the weekend I pulled out the insurance contract to satisfy myself that it would be covered and exactly what had to be done. My conclusion was that yes it would be covered and yes, pre-authorization is required. Throughout the day today I spoke to the hospital and the supply company and everyone was working on the basis that pre-authorization is required. Then, at about 4:30 in the afternoon the representative from the supply company called and said “Good news! No authorization is required”. I asked her what she was basing that on and she said she had just gotten off the phone with the insurance company. I told her that person was wrong, not what she wanted to hear because she was ready to put in an order. She argued that she spoke to the company herself and had a “reference number” for the call.

I have enough experience to know that the reference numbers only indicate that you spoke to them, it has nothing to do with their obligation to pay. I pointed that out to her and her reply was that conversation was all she had to go by. As politely as my waning patience would allow, I reminded her that was not all she had to go by. I told her that I had spoken to them twice, her own company spoke to them prior to this, and I myself reached the same conclusion after reading the policy. That’s 4 sources that said authorization is required, 1 that said it’s not. Do you think that 1 may be wrong? She agreed to call them again.

Shortly after that the hospital called, happy to have heard from the supply company that no authorization is required and ready to go tomorrow. Again very politely, I told her no, they needed to get this straightened out and rescheduled to procedure. Shortly after that the supply company called to say I was right, authorization is required and they would be faxing over the necessary paper work. Had I proceeded without it I would have been stuck paying for at least the first round of supplies. Dopes.

I should be having the procedure later this week. I decided to do it because although I seem to be able to have the fluid drained every eight days, the sixth and seventh days are very uncomfortable. So I’m useless three out of every eight days. I hope to be more comfortable more often when I can drain myself. It’s only palliative but that’s all I have now.

In general I’ve been feeling better since I’ve been off chemo for a while. I don’t like the fact that there’s nothing fighting the cancer now but it is what it is.

Carry on.

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