Friday, July 5, 2013

For More Of My Blogs: Please Check out The Huffington Post

Hi All!
   If you've stumbled upon this blog for the first time, or if you've been reading for awhile,

I wanted to let you know I've begun blogging for the Huffington Post.

You can check out my HuffPo  pieces at the below website: 

Thanks for reading!

Tuesday, April 30, 2013

Stupid Cancer Young Adult Summit OMG 2013

 Since last year's summit, all I could think about was going to Paris Casino and buying one of those Eiffel Tower strawberry daiquiris. The reason why, is because last year I was in no position to buy one of those daiquiris. It was my first year going to a conference that would connect me with other young adult cancer survivors, actually discuss my feelings as a young adult cancer survivor, and find resources I didn't know existed to help me as a young adult cancer survivor.

Last year's summit was amazing, but all encompassing for me. I had never been to Las Vegas, so I tried to cram way too many things into the weekend.

This year, I wasn't going to let that happen. I purposefully didn't schedule tickets for theatre productions or attractions. I didn't even focus on finding the "best buffet on the strip." I went all in for this summit. I decided to be fully present. That was the best decision I could have possibly made.

This year, I went to break out sessions I didn't think I wanted to go to last year. I went to cancer as chronic, survivors guilt, and the just for girls session. You see last year, I was in the middle of writing my book and completely focused on health care legislation and insurance issues regarding my journey. I published the book last year, so this year I was free to focus on my emotions surrounding my journey.
And boy did those emotions pop out of nowhere. I actually cried for the first time in a long time. I even caught myself with wobbly voice when I spoke to others.

This year was cathartic for me-- but it was also incredibly fun. If you're even remotely considering going to this conference next year-- Do It! You'll meet great people, you'll reconnect with yourself, and you'll learn so much that you didn't even realize you might have wanted to know.

Tuesday, March 12, 2013

Statute of Limitations Medical Bills?

Maybe part of the reason Americans have a difficult time healing after a traumatic medical event is because of the potential non-health related aftermath.

As some of you are aware, I was in active monthly treatment for an arteriovenous malformation (AVM) from 2005-2010. Since that time my doctors are in a holding pattern, watching the condition with annual MRIs. Although those annual tests do remind me of the rough patch I've been through regarding those treatments, I usually try and not think about them. They were a huge financial burden, physically/emotionally draining, and although there are residual issues from the built up scar tissue etc... I really try and focus on my life now rather than living in the past.

Focusing on the present is difficult, however, when just yesterday I received a statement for one of those treatments done in May of 2008!

I'm not sure why a single bill from almost 5 years ago, that should have long ago been paid by my primary and secondary insurance (from that time), would just now resurface. Looking at the statement it appears my 2008 insurance companies were only first billed this past November (2012). That doesn't make any kind of sense to me though.

It's possible I still have an EOB (explanation of benefits) somewhere in the stack of paperwork I tossed into a file cabinet so many years ago--- but to be honest with you, the idea of having to dig through all of that to find one single piece of paper sounds like a punishment I wouldn't wish on anyone.  Don't get me wrong, if I have to do it I will do it. However, the fact that this is even a topic for discussion seems inherently incorrect.

Perhaps I'm wrong, but by this point if there was an unpaid charge wouldn't the hospital have written it off on their books?

I live at the exact same home address since before this billed treatment and I never received a bill until now for it. I also haven't received a bill for any of the other treatments I had done within that year. So why this bill? Why now?

I am not the only one who has received medical bills for a surgery/treatment years after the fact, but I do not understand how this occurs. No one can tell me with a straight face that the hospital simply "forgot" I had a treatment and only remembered 5 years later.

No wonder Americans (particularly-because we are the only ones with an insurance system like ours) often times are unable to pick themselves up after a medical trauma.  How can someone completely move on when they are unexpectedly reminded of it again and again years after the fact?

Monday, January 28, 2013

...Or You Could Pay $4,150.00 Out Of Pocket

Every new year I go through the same game of trying to get my leukemia medication.

The game goes something like this:

It's time for me to pick up my prescription---
     However, I am stalled because the insurance needs to re-approve it for the new year.
The insurance re-approves it (which usually takes a week or two)
     However, they only re-approve it for the first month
I pick up my medication
     However, I need to have my doctors fill out more forms and fax them in over the month so I can hopefully get my medication the next month without any hassle.

This year the game was changed up on me.

It's time for me to pick up my prescription---
     However, I am stalled because the insurance needs to re-aprove it for the new year.
The insurance re-approves it (which took about a week and a half) BUT ONLY IF I RECEIVE MY MEDICATION FROM THEIR MAIL IN SPECIALTY PHARMACY

"Okay, Fine." I think to myself

So I call the specialty pharmacy who tells me they do not have my prescription and need my doctor to re-fax in all of the information including my co-pay assistance card.

My doctor faxes in all the information, insurance/copay cards in on Wednesday of last week and I am assured by the new pharmacy that everything will be ready to go within 24 hours.

On Friday morning I call, because I haven't heard anything and I figure I better check in.

I speak to a woman who informs me my copay is $4,150.00.

I tell her my co-pay assistance card helps with that and she tells me they do not have my co-pay assistance card on file. Frantically I give her all the information over the phone and she tells me she has put an "emergency" note on the file to get this shipped out to me.

I hear nothing.

So Monday morning I call to check back and am told they have all the information in the system and to check back at 4pm (Pacific Time) to make sure the medication goes out tonight.

I call at 3:50pm (Pacific Time) and a new person tells me it will take another 7 Business days for them to "verify" my co-pay assistance--- OR I COULD JUST GIVE THEM $4,150.00 AND THEY WILL SHIP IT OUT TONIGHT

I hope each and every one of you has that kind of money laying around for one month's worth of medication--- but I'm guessing I'm not the only one who does not.

The only way to get any of my Daily Leukemia Drug for the month of January is to have them over-ride the system and allow my regular pharmacy to go ahead and fill the prescription.

I ask them to do this--- and they tell me they are only open for another half hour so I need to call my local pharmacist, have her try and run the prescription through the system, get a denial number, call them back with that denial number, and THEN they can release it to her so she can order the medication for me to receive before February 1st.

I hate to make assumptions--- but isn't it convenient that the insurance company doesn't have to pay anything for January if they can't have the drug approved until February?

My local pharmacy originally tried to re-fill the prescription on January 10th. The December prescription ran out on January 14th. Today is January 28th.

Anyone else see a problem here?

Wednesday, January 9, 2013

Health Insurance and Profits: Capitalism is not to blame

Today I read this article in the NY Times:

For those who read this blog and The Malformation of Health Care book  you already understand my position on what this article says (the author is preaching to the choir).

I find it fascinating that no matter how many discussions, articles, programs, books, take on this topic; these companies still have the audacity to continue acting in bad faith.

What will it take for incredibly high powered, well lobbied, excessively wealthy companies to become accountable for bad practices?

I'm sickened to say, probably "nothing".

Despite the claim that corporations are people, corporations (especially on this high of a financial level) do not have an internal moral compass. Most people who work for these companies are at the mercy of this corrupt system just as much as the customers who pay their premiums each month in hopes their policy will cover them should tragedy strike.

This is not capitalism. This is greed.

The reason I say this is because I know what the ideals of capitalism are, I grew up on them. My family owned a small hardware store for over 100 years. The reason the company lasted for 100 years was because of the pride taken in our services and products. We didn't force anyone to shop at our store, but we gained loyal customers, based on our integrity.

We offered competitive prices and guaranteed our products and our work. If a customer came in to the store and said a product was faulty and we didn't either exchange the product or fix the issue, we would have been run out of town. No customer would have shopped with us.

When a health insurance customer comes to the provider with a problem, many times they are ignored, avoided, or told of a previously undisclosed "loophole" that frees the insurance from all coverage obligation.

Capitalism only works when those servicing the population understand that first and foremost they are performing a service for the community. Profits come when that service is performed well. If that service is performed poorly, profits should be reflected.

That is capitalism.

That is not what is going on currently within our health insurance system.

Thursday, December 27, 2012

Stalling Tactics To Avoid Appeal

Hi everyone!
     I hope you all are enjoying your holiday season. I know I have been doing my best to focus on family and friend gatherings and celebrations rather than typical daily life. However, I'm realizing that I can not simply stop working on important outstanding items so I'm rejoining the world today.

 It has been awhile since I've updated you about my insurance situation. When last I wrote, I spoke about ERISA and how the law is interpreted to give the client only 60 days to appeal a cancelation of benefits from long term disability companies. I also discussed how I sent in my appeal along with a second certified/signature required letter request for my entire case file to be sent to me within the month.

Yesterday marked day 20 of the insurance company signing for said letter and I have heard nothing. I decided to give them a call to check up on the progress of my request only to find out that although they had the letter in their system, and indeed signed for it 20 days ago, they did not have it marked as requiring any follow up. Therefore, for the last 20 days, the company has simply not been working on the request. According to the worker I spoke with (the one who signed the cancelation of benefits letter-- and sounded shocked to hear from me, but then smugly asked how my holiday was) they will send me all of the documentation I requested within 7-10 business days.  I'll believe it when I see it.

Just a reminder of why we need to follow up with companies even if we've gone to all the trouble to send certified letters requiring signatures.

This is not the first certified/signature required letter this company has actively avoided responding to, claiming it was mismarked in their computer system. Therefore, I'm 100% certain it's a common stalling tactic that they hope will cause the appeal to be sent in late, and allow the cancelation of benefits to stand uncontested.

I'm glad I sent the appeal in despite not having all of the information I requested, because at least the process has begun and I'm not panicking over when this box of documentation will arrive and if it will be complete. Let's say I receive the box of information at the 45 day mark-- what if it's not all there? How long would it take me or an attorney to accurately go through it?  Probably more than the week I would have left before I would need to send the appeal letter in and make sure it arrived before day 60.

At least this way, should this case go to court it is not an "easily dismissed on a technicality" situation now.

Tuesday, December 11, 2012

1974 ERISA Law

I've been thinking a lot about the 1974 ERISA (Employee Retirement Income Securities Act) law since I received my denial letter from the insurance company last week. (Which by the way,  yesterday I received the returned signature cards showing they received the certified letters for both the appeal and documents request).

The reason I've been thinking about ERISA is because it was noted in my denial letter and according to my research this law has been exploited by many insurance companies in order to no longer honor their obligations to policy holders. 

I found two articles/briefs that got me thinking about my own experience. Both are worth a read if you have some time. Specifically the second one that discusses exactly how this law is used against patients in insurance cases.


One thing I found surprising is in my own denial letter. The insurance company informed me I had 180 days to appeal the denial. However, with ERISA I really only have 60 days or a judge could throw out any future lawsuit regarding the case. 

I have a solid connection to a law firm willing to represent me, but I wanted to fully explore my options so I contacted a local firm that specializes in ERISA law. When I queried them I received a response back that this specific firm only represents the insurance companies with their knowledge of ERISA, not the patients. Of course large companies with large legal budgets are where the real money is, so from a financial perspective I understand that law firm's decision. I'm saddened though that this firm would use its knowledge to support companies known to abuse this law. 

The loopholes this law offers, I'm sure were unforeseen in 1974. However, over the years companies have discovered new exploitation methods using older laws. It's sad... and we're clearly at a point when these laws need to be changed. 

When I spoke to the insurance person who sent me the denial letter (before the denial was ever sent). He informed me this was "nothing personal"-- it was simply business. 

I would argue, "business" set up on loopholes and a year end bonus structure that encourages vilifying an honest policy holder, is very personal. Making up false claims about another human being in order to receive a year end bonus for saving the company money, is very personal. Trying to use intimidation tactics to harass a client because you know that client is not allowed a jury trial under ERISA, and you will never have to answer for that harassment, is very personal.

I am not a moral authority. I'm just an average human being whose integrity is being attacked by a company for the sake of money. And I'm wondering when the collective "we", as employees, stopped listening to our conscience and instead put all our trust in company policies meant to harm clients. 

I encourage anyone reading this to fully educate yourself on ERISA so you will have some basic knowledge should it ever be used as a tool against you.