Suddenly spring....

Last night was one of the Pagan spring festivals, and today, it's going to be 60 degrees in central Oklahoma.

Of course, that's actually because I finally bought a decent winter coat on Friday.  HAHA!

Treatment session #2 is in the history books.

This past week, I experienced increased mouth discomfort to the point of getting the sores on my tongue again like before.  Prescription oral rinse obtained, and 36 hours later, the sores are gone.

That stuff works really well.  Thank goodness, because those fuckers HURT.

Unfortunately, our insurance forced us to change pharmacies, and what used to cost me $7.50 now costs $55.00.

Brilliant.

Anyway, speaking of insurance, we had quite the roller coaster ride this past week regarding my coverage and whether or not I would be allowed to continue to receive chemotherapy treatments on schedule.

I was off last Monday for the Martin Luther King holiday.

Around 4 that afternoon, my cell phone rang, and it was the clinic.

I hoped they were calling to say that I was able to get a doctor appointment on the same day as my treatment in 3 weeks, instead of having to go twice in one week.

No such luck.

It was the insurance coordinator, calling to say that my insurance was now requiring pre-authorization for chemotherapy treatments, and that I might need to stop coming until the insurance authorized the service.

It seemed very strange to me that I had already received a treatment, and this was not an issue, and now was approaching my second treatment, and suddenly it was a issue.

How could the clinic have NOT KNOWN about this new requirement?

Insurance companies are required by law to notify their participating providers of rule and policy changes well in advance of said changes effective dates.

She had said that this change was effective January 1.

I said "Okay, so I scheduled these appointments on December 2, so I don't quite understand the problem."

She was not very good at answering my question, so I just let it go, without telling her that I have been on the business side of this process for about 16 years, doing medical billing, and several of those years fighting denials on behalf of medical providers.  I know about denials for authorization!

I comforted myself in the knowledge that if the auth did not come through, I could still get my treatment, and the insurance would charge it to provider (my clinic) responsibility, and not patient (me) responsibility.  The clinic would then fight the denial and get it reversed.

Because that's how it always was when I was working on behalf of medical providers!

As of Wednesday, still no authorization.

It was after 4:30 pm Thursday before I heard from her again, and she said there still wasn't an authorization.

I asked a few more questions, this time, such as "HOW DID THIS HAPPEN?"

I told her that I know that the insurance had to notify their providers in advance, and she said "they didn't allow us to start requesting authorizations until Jan. 1, so we're behind."

Okay, finally an honest answer. YOU'RE behind.  I get that.

But really?  They didn't ALLOW requests that they required until after a certain date?  That seems awfully odd to me.  In fact, that seemed highly unlikely, given the standard 15 day turn around it takes for a typical authorization.

The insurance knows that patients are scheduled for treatments in January, so they would allow auth requests in advance.

Then I said "well, if I come for my treatment anyway, lack of auth is the provider's responsibility, and you can appeal, and request a retro auth."

She seemed a bit confused for a moment.....since I was saying stuff she didn't expect me to know about.

But then she said "They don't do those, and no, it would be your responsibility."

"Why would it be patient responsibility if it's your job to get the service authorized?"

"Because you would know that the service wasn't authorized."

Really?  Seriously?

I questioned my medical billing friends via Facebook, and they ALL agreed, auth is the provider's responsibility, and the insurance CAN'T bill me for lack of auth.

SO, I got off of the phone with her, with the assurance that I would hear from her by 10:30 am on treatment day with an answer.

Then I had Dave call the insurance company and ask the provider vs patient responsibility question.

Apparently, OUR insurance WILL BILL THE PATIENT for the provider's lack of follow through.

So that meant that if I DID go anyway, I would be billed $5k for an hour and a half in the infusion room.

Charming.  SO, it was down to no auth?  No treatment...and a possible wait time of as long as three weeks before I could start up again.

This did not sit well with me, but what the fuck was I supposed to do about it?

Anyway, the stress from all of this was really getting to me, so Dave took the process over on Friday morning.

He called my nurse, who had NO idea that any of her patients were going through this kind of stress, being told by the business office that they would have to stop treatment because the business office was behind in their work.

She intervened with the business office, and said we would hear something as soon as possible.

Friday 10:30 came and went.  No promised call.

12:00 came, time for me to either punch out for the DAY, and go for treatment, or punch out for LUNCH, and come back at 1 to work the afternoon -- because I would not be allowed to continue my treatments.

I punched out for lunch, and one minute later, the chick in the business office FINALLY called and said "SHE" got the authorization for me.

I was so relieved that I just said thanks and hung up.  My suspicion is that the nurse lit a fire under her.

I emailed my supervisor and asked her to change my punch out for lunch to punch out for the day, and bid my co workers a good weekend.

PHEW!

What a freaking pain in the ass that all was.  All because someone in the clinic wasn't doing her job.

While I was getting hooked up for my treatment, Dave went to the business office and had a little chat with Miss Jessica.

He confirmed that we won't have to go through this every freaking week now.  ALL of the treatments in this weekly protocol have now been authorized, which they SHOULD have been before we started treatment on January 15th.

UGH!

Anyway, it's been a good weekend so far, mostly.

I don't sleep the night of treatment, it must be the steroid.  And I get horribly constipated.  But that all resolves as the weekend goes by.  Well, the insomnia, at least.

We are going to use this spring like day to drain and refill the hot tub.  It's overdue and really needed to be done.

Enjoy your Sunday, gentle readers!