I received a letter from BCBS in the last three weeks, explaining that they received my appeal to cover Perjeta. Another letter came, explaining that the appeal had been handed over to XYZ oncologist with blah-blah-blah credentials, who had determined that it was medically necessary to my case and should be covered. HOORAY! What a quick turnaround to a positive answer on that depressing and saddening news from my last appointment!
Today was a new day and I was completely prepared to talk about more miracles in this journey brought about by the power of faith and hope and prayer. After having labs drawn--by accessing my port!---I had even more reason to rejoice. Then, I met with Dr. Cole, who talked about how she hadn't heard whether the insurance would be covering Perjeta, but that didn't worry her. If we needed to just continue without it, my cancer has been "so quiet" that not having perjeta at this time doesn't give her cause for concern.
I tried to show her the letter of coverage that I received, but all the insurance papers were mined together in my bag. I couldn't locate the correct information!
I asked the financial person in her office to help. "What responses has Dr. Cole received on my appeal process for Perjeta?"
The only one she could find was from a a claim from DECEMBER 2018, where the insurance eventually covered the drug at 100%. But, that was it. There were no claims from the last 6 months of treatment. How was I to know that BCBS would be paying for all of those----or for every three weeks for the rest of my life? There was no response or record of the letter out of my mailbox....and I was starting to wonder if I had imagined it.
I called the insurance. There were NO CLAIMS on record for any other dates of service that included Perjeta. WHAT???!!!! 😡. From the first appointment in DFW, I brought proof of my Perjeta drug assistance program. In College Station, a claim was made for the drug. The insurance accepted or denied. Appeals were made until it was eventually accepted. The insurance sent a bill for my portion of the cost, which was high until my deductible and out-of-pocket were met. The balance information was sent to the drug assistance program, who sent a check to the clinic until my deductible was met. Bada-bing, bada-boom. No such luck here.
I'm on the phone with insurance, trying to explain that Perjeta is not just a "claim" for me. It's great that they covered 100% of what was owed in December, but that doesn't ease the anxiety. "I am currently at my cancer clinic, trying to decide if I will be able to continue with my treatment plan which includes an infusion of this drug every three weeks for the foreseeable future." This customer service person, bless her heart, couldn't give me a simple, straight answer. She didn't know. The financial person at the clinic couldn't give me a simple, straight answer. I was caught in a loop between insurance and billing and NO ONE COULD TELL ME HOW TO PROCEED (and not be suffocated under hundreds of thousands in bills from the cost of what wasn't covered by BCBS!!!!!!). The other frustrating this is that this big company (UT Southwestern) doesn't work like my CS Cancer Clinic. It's on a much bigger scale, and they only bill monthly. There is no individual or personalized billing. No one is in house to truly answer questions. No one is here to go to bat for me and call the insurance to fight. I am a one-woman army against the world.
It got to the point where I needed to make a decision for today. No Perjeta. And, no more wig, as it was too tight and too itchy when I was trapped in a wormhole and starting to tear. up in frustration.
Wig off. Decision for today made. Would have to try to fight this battle another day.
I took a moment to feel sorry for myself.
"It's not like I don't have anything else going on! Can it not be enough to just battle cancer? Is it not painful enough to endure the side effects of drugs and infusions and the stress of ACTUALLY fighting cancer???? What about the financial stress of the whole thing? Plus, there's the regular ups and downs of being human + trying to navigate life while keeping my little humans fed + clean + safe + alive. Can I not just find someone who can give me A SIMPLE, STRAIGHT ANSWER ON THIS?????
And then an answer to prayer came.
"It will be okay.
You may not know how now, but it will be okay.
Dr. Cole isn't worried about going forward without Perjeta.
If you are able to work it out, that's just a bonus.
It will be okay."
With that, I put away the stack of papers I was trying to navigate to locate the insurance company's decision to cover my drugs. I asked for something to eat and drink and bundled up in my blanket, trying to relax and allow my BP to return to normal.
I don't know how, but it will all be okay.
I can keep on with my goal to BEAT(kick) THE HELL OUTTA cancer.
To document:
This itchy rash, which two dermatoligts + two primary care physicians + two oncologists + various nurses/CRNAs/family/friends have not been able to truly diagnose or treat has been ramping up since my last treatment. This means lots of burning pain and itching. It also means wearing bras as little as possible. Maybe it's not all that bad.
I keep telling myself it's my body's way of eliminating the bad stuff from chemo drugs.
It's not serious enough to stop those, so I just suck it up and keep going.
