This Means War

Do you remember in my first blog post, I said I would offer up some tips from my experience with these preventative surgeries?  Well, get ready for your first one.  Are you ready?  OK.  Before you even THINK of getting your primary care physician to order the test to see if you even have the genetic mutation, make sure you have a rock solid health insurance policy.  I know Healthcare has been a big topic of conversation lately, and honestly you don’t realize how broken our system is until you have to go through major surgeries.  I imagine how much simpler this already difficult process would be if Humana, my health insurance company, actually took care of me.  On their website they say “We strive to be your lifetime partner in reaching good health.”  Well, that is only true until you ask them to actually pay for something besides a yearly physical or a trip to the clinic for a cold.  The level of frustration I have reached from dealing with them is enough to make me want to scream.  Really, after talking to other people going through this same process, they are having the same problem with other companies.  It is a matter of greed and health insurance companies not wanting to affect their bottom line by paying for major procedures (ones that could save TENS OF THOUSANDS down the line by preventing the disease from happening, by the way).

We left off with starting the process of getting an appointment with the genetic counselor at the Margaret Niedland Breast Center.  I had my appointment all set up when I got a call saying that I needed an authorization from my primary care physician (going forward, we will just call her PCP for ease of typing).  The funny thing about PCP’s is, some are very helpful and want to do everything to help you.  But then, some are completely useless and look at you like you’ve got three heads whenever you suggest doing a test that isn’t part of their everyday repertoire.  Mine was the latter.  She actually asked me “Why do you want to do this?” after telling her about my family history.  After brow beating her with my newly found information, she finally agreed to the test but then had no Earthly idea where to find a test because she had never ordered one before.  Apparently, my original option was not in network. So folks, here is your second tip:  Get a competent PCP before you start this process too.  Long story short, the lab I used just happened to have a sales rep in the office and she ordered a test through them, leading me to believe it was in network through Humana.  In the end, Humana refused to pay the claim stating that the lab was not in network and I didn’t have an authorization on file, which is wrong on both counts.  This isn’t even the worst of it.

With my positive BRCA result in hand, I started making appointments with specialists.  Every person I talked to recommended the same guy: Dr. John Rimmer.  He was not in network, but he was the best so we decided to pay out of pocket and let Humana cover the hospital and anesthesia bill.  Wrong.  Insurance reps are maddening because from day to day, you get different excuses as to why they will not cover your procedure.  It started with the fact that Dr. Rimmer was out of network so they wouldn’t pay for anything.  Then, it was the fact that our specific policy didn’t cover prophylactic surgeries. In short, we will wait for you to get cancer before we will help you.  This fight isn’t over and it will probably continue through out the year, considering I will then have a hysterectomy to get processed in November. I am trying to remain hopeful that Humana will come through for me, but it gets harder and harder to stay positive every day

This post rambles on, and I am sorry for that because I am usually concise with my thoughts.  But I want you to be aware and ready for the war you might have to wage on your insurance company to get the care you deserve should you decide to go the surgical route with your new BRCA diagnosis.


One thought on “This Means War

  1. This is definitely very frustrating!! We have coverage for emergency room visits and because my gallbladder surgery was out of state (which shouldn’t matter) they were trying to charge us $39,000!!!!! I was there for a little over 24hrs! We about died when we got the bill. Dan worked his healthcare experience and magic and got most of it erased luckily. Don’t give up bugging them bc eventually you will figure out something that works for you 💗

    Liked by 1 person

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