Sunday, August 8, 2010

Ridiculous Insurance

Well, our Case Manager Cindy called me Thursday and told me that they have decided to not cover Tanner's chemo in Fort Worth either. They have deemed it "experimental" just as they have the chemotherapy that was performed in Arkansas all last year.

I wrote to the Department of Insurance appealing their decision and US Health and Life responded to them and said that they had made many exceptions in Tanner's case (one being assigning us a "Case Manager") and that even though their "experts" had decided that Tanner's chemo was experimental, they (US Health) had covered the chemotherapy treatments -- they just didn't cover the drugs used.

What?? What in the world did they cover?

I guess the insurance company decided since the DOI determined they couldn't help us with the chemo situation in Arkansas, they would go ahead and deny service in Fort Worth too (even though, from what we can determine, they have been covering these treatments for months now). I asked Cindy (the case manager) if this meant they aren't going to cover any of the maintenance chemo treatments he's been receiving since December and she said that was correct, they have deemed it all "experimental".

Also, they said they covered one stem cell transplant but when we go through all the EOB's, we can't find anywhere that a transplant was paid for.  Around the time that the first transplant was performed, there is a charge for around $43,000 and the insurance company only paid approximately $900 on those charges. If this is what they are talking about, I don't think that is anywhere near "covering one stem cell transplant'.

I called our case manager on Friday morning asking her to please call me back and tell me when and what they paid on the transplant. She hasn't responded yet.

When I received the call informing me that they have decided not to cover the maintenance chemo either, I just broke down at work. Afterwards, I called my mother-in-law and she told me that getting upset didn't help, but sometimes I just have to cry.

I cry, get it out of my system, and then move on and function again - but occasionally I just have to to let the tears come for a while. I've found that while I'm dealing with Tanner's illness and all that that entails, I have so much less patience for all the other areas of my life. I am so easily upset and end up with bruised feelings.

Sometimes I just have to hurt.

Tomorrow, I'll move on and deal with everything and we'll get it all sorted out.

"When you're dreaming with a broken heart
Then waking up is the hardest part
You roll outta bed and down on your knees
And for a moment you can hardly breathe"