The insurance promised that our expedited request for approval for the splenic irradiation would be in our hands by 4 PM today. It is almost 9 PM and I just heard from my insurance case manager and the reviewing physician still has not given her an answer. A doctor in Arizona has information from several of my trusted physicians, trying to determine without ever seeing me, if I am deserving of his approval for the radiation. This entire process is maddening for patients and physicians alike. In a million years, no one will ever convince me that with medical matters as serious as this, that a long-distance physician who looks at a pile of papers is competent and capable to determine if I receive any given treatment or not.
Appointments await me TOMORROW to complete the planning and simulation session for the radiation. I suppose the reviewing physician will wait until the very last moment and notify me. If the decision is to decline payment for the radiation, I will be forced to cancel the appointments at the last minute tomorrow.
In the last year, this process has denied syringes that I require for the two IV medications to be inserted into my sinuses. So, we are paying for the syringes ($100 per month). If my doctor had not researched and found this method for me to receive these two drugs, the insurance would be paying for two daily IV's instead - and I can guarantee them that two daily IV's would cost them much more than $100 per month. Multiple appeals have failed.
The reviewing physician initially rejected the IV antifungal that I needed for a pulmonary fungal infection. My doctors battled an appeal through and did obtain coverage for the IV's.
The insurance has twice rejected the requests to pay for the milk that has benefited my immune system. I have not been in the hospital or for outpatient IV's for almost a month now that I have been drinking milk. Given that the last week in ICU cost the insurance over $30,000, one would think that purchasing milk for me would be a no-brainer.
And now we sit and wait to see what treatment the physician reviewer deems me worthy of receiving. I am so disappointed at what health care in America is coming to - and it is only going to worsen. Perhaps you or a loved one has never been faced with these scenarios, but take my word, if you are faced with a serious illness, you will be shocked at what the "insurance gods" will put you through. I am knowledgeable about my condition and care and I am very organized. Yet, at times, all of this insurance mayhem is overwhelming.
I am certain, on paper, my life does not look worthy of salvaging with another expensive treatment when the reviewer reads terminology such as "end stage disease" and "a year to months to live" in my records.
Just ask Lil Man what his Grammy's life is worth!
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