Monday, June 29, 2009

Insurance Update

Last Wednesday, Michael and I departed for a work-related trip to Atlantic City. If you'll remember, we were expecting a call last Thursday from Blue Cross regarding whether or not our request to change medical groups prior to open enrollment had been granted. While Michael was preoccupied with work, I was consumed with anticipation waiting for that call to come in. Towards the end of the day, we still had not heard from Blue Cross and so I called them only to learn that our contact there was out of the office for the day - we were never going to hear from them.

I then called my school district and our contact there said she'd called Blue Cross earlier and got the same information. We both agreed that we'd start calling Blue Cross Friday morning. But, when we did so, we learned that the person we were supposed to be hearing from was out of the office for the day again! At that point, the woman from my school district said she was going to make some other calls and see what she could do for me.

Late Friday afternoon we finally got a call from Blue Cross.

They denied our request.

Oh, and as for that requirement by law that they inform us of their decision in 72 hours, they said that just means that they have to have a letter out in the mail to us in that time frame. Can you believe that?

They said that we might still be able to receive treatment at UCLA if our current medical group approves it. The doctor at UCLA was required to submit a "treatment plan" back to our current oncologist and medical group, and now our they will review the "treatment plan" and determine whether or not they will let us continue with UCLA. When I complained about their lack of responsiveness to our request and their decision, all the representative did was quote policy and contract language back to me. Those of you in favor of socialized (government) medicine better wake up and realize that HMOs are shades of what's to come - bureaucrats standing between you and the health care you need waving their lousy policies and contracts in your face and denying or delaying your treatment.

So, that's where things stand right now. We are busy working the phones this morning following up with all parties involved to make sure that our request is not falling through the cracks.

This has become very stressful. I am ready to pull my hair out. Actually, I'd rather pull some other people's hair out instead...

I hope my next post will be something lighter. We did have some fun in Atlantic City and I want to post about that.


Alex and Jill said...

I know how difficult insurance can be. We fought for so long to get ours to pay for our IVF. They are always looking for a loop-hole to get out of having to pay...frustrating since we pay so much in premiums.

I won't stop praying until their answer is YES!


Shannon said...

UGH! I'm so sorry you are having to deal with insurance craziness. Praying progress is being made and that you and Michael can focus on health and healing. =)

AprilMay said...

I want to pull their hair out too!!! I mean really. WHAT is the problem with letting you switch a lousy month early? Is it totally evil of me to hope that whoever decided that has some health issues of his or her own to deal with someday?? I am so sorry!!

Kate said...


I am so sorry about this. I feel your frustration and I wish I could change it. I am just so sorry.

But also...I WAS IN ATLANTIC CITY last week (actually Brigantine...and island right outside!! My sister has a condo there and since we live the closest...we take advantage often!!! Please let me know if you ever make the trip again...would love to meet you in person!!!)

With prayers...and hope (I have lots...and faith too...if you get low...I am here! :-))...and prayers...


Kathy and Joel said...

I really don't understand the way insurance works in the States. If you're sick, you should be able to get better no matter what the insurance company says. It just all seems so backward.

mekate said...

Gosh I am so sorry for the frustration on top of all of this. Energy needed to be your own advocate, when isn't there barely enough to get by when things like this happen? you are superwoman, and I hope that you will be able to have Michael treated at UCLA.

I would be pulling my hair out for sure. I am so sorry for the additional struggles. Wishing you continued fortitude, resilience, wishing you continued strength.

hugs, Kate