Life's Journey

I haven't talked much about Insurance since the whole radiation incident at the beginning of treatment, but I feel that this is a topic that should be discussed.  I know there are a lot of visitors to this site that are also facing a journey with cancer so I thought I would share with you some of my insurance revelations.  Here's the thing, health insurance is big business, they don't care about you or how much money you've been paying them over the years.  What they care about it the bottom line. 

I'm a planner.  I like to research and educate myself before jumping into something, I mean you always want to know the temperature of the water and the depth of the pool before you dive in - right?  Before I went in for surgery I called my insurance company to (1) ensure that everything is covered and (2) talk through potential charges and try to get an idea of how much all of this was going to cost me.  I knew that I was going on short term disability and budgets were going to be tight so I wanted to have some idea of what to expect.  In talking through it with the helpful agent on the phone I realized that it may not be too bad.  I had a Max Out of Pocket limit on my policy of $3000 and a Deductible of $600.  She explained that this meant that once I paid $3600 I would be done with the exception of perscriptions.  While this is a significant amount I did a little happy dance in my chair since I was expecting a much higher number.  I asked her again to clarify that this was the cap and she confirmed.  I asked her to look for the fine print and again explained my situation (of course at the time I didn't think this was going to be cancer but I did explain that it could lead to further treatment) and she once again confirmed these amounts.  I was proud of myself for looking into this and felt a little weight lifted going into it. 

When I got home from the hospital and was recovering the bills started pouring in.  I was getting bills from the hospital, my oncologist, the anesthesiologist, the pathologist, the labs, the radiologists, everyone wanted money from me.  I was having a hard time figuring out what had been through insurance and what I really needed to pay.  So I put them all is a pile and waited for them to process further before researching.  As I started coming off the pain pills - I recommend this as a first step because this stuff is mind numbing without the pain meds - I started sorting the bills out.  I literally sat at my dining room table and had stacks of bills sorted and sprawled out everywhere in an attempt to organize.  Then I started writing checks. 

Ok, first...  track EVERYTHING.  Don't think that anyone else is going to do this for you.  It's unfortunate and it's the last thing you want to think about when going through something like this, but take the time to organize and track it.  When I say everything...  here's what I mean...  E-V-E-R-Y-T-H-I-N-G!  Keep a calendar of your appointments, put all your reciepts in an envelope or file, when you pay a bill keep it and file it, when they charge you a co-pay get a receipt... everything. 

Second, stay on top of your insurance.  Here's what I quickly learned...  they will take their sweet ass time negotiating with the medical facilities and making their payments.  The medical facilities will not always wait for the insurance before coming after you for the money.  Make sure you are only paying what you are responsible for and sending the rest back to your insurance.  The insurance will also not track your Max Out of Pocket balance for you.  Although this seems logical and would be beneficial to everyone involved...  it doesn't happen.  My suggestion, open up excel and build out your own spreadsheet and balance tracker.  Ok, I'm crazy color-coded and ocd when it comes to building out tracking spreadsheets but seriously, it's worth the time in the end to do this from the start.  I anticipated the insurance company helping me more with this and having better record keeping on their website.

So, once I paid my $3600 I was responsible for I quit paying.  I held on to the bills but figured they would process through my insurance and get paid.  Um, why do the bills keep coming?  Why is this one now coming in a pink envelope - while I love pink, that can't be good?  Here's the catch - you have to keep up with the insurance to know which portions to pay to who.  OMG - this task seems next to impossible.  This is how people end up paying so much more because the insurance makes it so hard to know who to pay what and the medical facilities will just keep billing everyone until they get money.  UGH!

I called back my super helpful insurance agent lady to help me through this.  All of the sudden she was not as eager to assist and she no longer appeared to have that happy smile in her voice I heard prior to my treatment.  Well hello Jeckle & Hyde.  She told me to look on the website and have a good day.  Yeah, not so helpful.

I finally thought I had it all balanced and paid my Max Out of Pocket when:
Ring Ring
"Hello, this is Sarah"
"Sarah this is CBD, we are collecting an outstanding debt on behalf of Banner Hospital in the amount of $792.08"
"Wait, what?"
"Yes ma'am, you have an outstanding debt in the amount of $792.08 with Banner Hospital, I'm also showing a collection in the amount of $1476.84 with Arizona Oncology."
Once I picked my jaw up off the floor I explained that I had paid my copays on all my bills and that these should be taked care of by my insurance.  She in turn explained that once the bill has gone to collections both the medical facilities and the insurance are no longer involved and it is my responsiblity and my credit on the line.  Holy crap!  So she explained that my best option is to go ahead and pay these, then report to the insurance and get a refund from either them or the medical facility.  Cause yeah, that sounds like fun.  I asked her to please put the case on hold for 30 days while I consult my insurance company - ok, this is a good tip for everyone, they MUST do this for you if you tell them this is in deliberation with your insurance.

Here I go calling my oh-so-helpful insurance agent again.  I explain the phone calls and the pink envelopes that are coming in.  She explains that it appears that these bills are an accrual of copays with these medical facilities.  Ah, easy peezy I thought, I've already paid my Max Out of Pocket these should come back to you.  That's when she dropped the bomb: "Oh, copays aren't included in your Max Out of Pocket balance".  HOLD THE PHONE!  WHAT?!?!?  She expained that the 20% balance on the previous bills is coinsurance not copays and that my Max Out of Pocket only includes the coinsurance amounts.  There it is...  the fine print that no one tells you about and it's a doozy!  I snapped...  well it's not really a MAX out of pocket then is it?!?!?!  Why didn't anyone explain this to me when I called to inquire about expenses, why can't I find this information ANYWHERE on the website?  The website they told me was the all powerful Oz of information?  "Yes" she says "it appears this information isn't posted to our website but it can be found in your policy documentation"  Ok, in this day and age, who still recieves a paper packet of documentation?  Everything, as they had been telling me all along, is "posted to the website"....  except the fine print!  Next piece of advice - find the printed policy and read every line.  Yup, there it is, copays are not included in the Max Out of Pocket expense limit. 

Now I am drowning in a sea of collection agencies and pink envelopes.  My credit card balances are racking up and my pennies are being pinched.  In the beginning of this long drawn out story I mentioned that you should keep track of all of your appointments and everything.  Here's why.  When I took the 25 page bill from my oncology office I found a few discrepencies.  There were a few applied copays that should not have been there.  One day I was charged 4 copays (lab work, chemo, radiation, and an injection) while they were all done in the same facility... 

Here's my final piece of advice in all of this...  learn how to play "Let's Make a Deal".  The catch is that once the bill has gone to collections, it's too late, Whammie, No Deal!  But, if you work with the medical facility before it is sent to collections you can usually work out a reduced total and a payment plan.  It costs them more to send it to collections, they will avoid that if they can.

In re-reading this I realize maybe I just have a super crappola insurance company so I did some quick research - nope, I have one of the top companies. I've learned a lot about the healthcare system and there is definitely a significant room for improvement. For those of you facing a medical journey of your own I hope my story helps you avoid or better prepare for some of the headaches that I faced. This was one part of the journey that caused a lot of unnecessary stress. But, I will continue pinching my pennies and chipping away at my new found debt as I can...  in the end I realize that you can't put a price on saving your life - right?  Outside of these headaches I am doing well, enjoying getting back into the swing of life.  The adventures have only just begun...