There are many things I wanted to title the post- but all of them involved the F word and I thought that might be a bit much.
If you’re my friend on facebook- you likely know that we’ve had some issues with our lovely insurance provider approving my LIFE SAVING meds. We first learned they hadn’t approved my treatment the day before I got my port while Justin and I attended our Chemo 101 class (fun times, btw). This was several days after the orders were placed (placed on a Friday- this was the following Thursday). Justin asked the nurse if we could call to help things along and she it’s not required…but appreciated if we wanted to.
So while I was getting my port placed the next day- a full week after the orders had been submitted for approval- Justin spent over 30 minutes on the phone (mostly on hold) trying to get things figure out. They claimed that they didn’t have anything in their system.
Justin also talked to my doctor’s office- who assured them that not only had they sent in the orders, but that they had records of our insurance company responding to that communication.
The following Monday- Justin called AGAIN and didn’t get too far. However we did learn that they had approved ONE of the 2 meds that needed the preapproval- so we were waiting on just one.
Since then Justin communicated with them a couple more times- as well as with my doctor’s office.
This Monday- I emailed my care team and informed them that I need to start ASAP. Carl is large and right under my skin and likely hormonal changes (I had been on my period) caused him to feel bigger than ever and I just want him OUT.
My nurse contacted the financial department of the medical foundation who in turn contacted our insurance AGAIN. They answered the questions the insurance wanted and were supposed to expedite the request.
In addition, Justin called them. Again. And again the rep was unclear on what was going on and wasn’t able to get information from the pre-auth department.
I decided I was going to give them until 10:30 am Tuesday and then *I* was going to call. Well, 10:35 came and I called.
I got a male rep- who basically said yes- it’s pending approval. I told him, that I understand that- but I need to talk to someone else to find out the status on this- like how long will this take. He told me NO ONE would be able to tell me that information- and that the only people who know anything else are in the pre-auth department but that they wouldn’t be able to tell me anything either. He also told me that they only just received the orders yesterday.
Um yeah no.
So…that’s when I told him that I am a mother of FOUR, and have aggressive breast cancer and I need my chemo approved NOW because I have a chair waiting for me Thursday and I cannot wait ONE MORE DAY for them to get their act together and that this is unacceptable. I assured him that I understand that none of this is his fault- and that I understand he has NO control- so he needed to transfer me to pre-auth N O W.
So he did.
I was on hold another 4-5 minutes and then got a female rep from the pre-auth department. It was basically a repeat of the info from the first rep- however I stopped her and told her that look- I am not going to argue with you but the orders were sent 2 weeks ago. I explained that I don’t know WHAT is going on, but I need this approved. She says she sent an email over to tell them it’s urgent- and then she tells me it says it should be approved by Thursday.
Wrong thing to say.
At this point- I again explained the whole I am a mom of 4 bit….and went off about how unacceptable this all is…and then I told her if they didn’t approve my meds by 4pm I was going to file a formal complaint with the State of California.
And then, I hung up on her. (Sorry female rep. it wasn’t personal).
This was around 11am.
Justin called them after 1pm to check in (haha they must hate us at this point). He is told it’s been approved. However they also told him they wouldn’t actually be faxing the approval letter for a couple days (!!!!!!!!).
Yeah….. are you feeling rage too? Or is that just me?
ANYWAY- Justin asked to transfer to the pre-auth department to go ahead and make sure that letter was faxed ASAP. I mean how long does it take to fill out the basic form??
After being on hold for a good 5-10 minutes, the pre-auth department answered and told Justin they faxed it over.
I emailed my care team to let them know so they can look out for the authorization. I was SO HAPPY to get started!
Then- I got a message at 4:50pm Tuesday afternoon from my Oncologist’s nurse…there is a possibility I can’t start on Thursday as we hoped- even with the authorization- because they couldn’t order my meds until they got that approval. And they are unsure that they will get there in time.
I had not cried in several days. But reading those words…immediate tears ran down my face.
I want to HEAL.
As I finish this post up on Wednesday morning while my kids are at their amazing homeschool co-op…I have not heard anything yet. I brought my pre-meds with me in case I get the call that I get to start tomorrow….I’ll keep you all posted…
(Also- another HUGE note of thanks to all of your messages, texts, emails and offers of help. I will be writing up a post on ways to help us later. We love you all!).