Today I am full of righteous indignation. I am angry, and my rage is directed at the healthcare system and insurance companies. Inside I’m roaring so loudly that they must feel the quaking of my fury. My wrath is properly directed because they are wrong.
Since May 20, 2015 I have praised my Blue Cross Blue Shield PPO Gold Plan. From MD Anderson to pharmaceuticals and multiple doctors, my coverage was excellent. As a contractor with home health agencies I was ineligible for group plans, and therefore chose an individual plan with a decent deductible and vast coverage. Because I drove so much each day for work, the assumption had long been that eventually I would be in an injury car wreck. Instead I got cancer.
I met my deductible on this plan 1 week following my diagnosis due to blood work, scans, and multiple office visits to different doctors. I raved to everyone who would listen about how well we had been treated and how comprehensive this plan was. I felt as though my needs were met and I was appreciated as a client. This autumn I was informed that BCBS was dropping all of it’s individual PPO plans in Texas, affecting upwards of 360, 000 clients, and none of their HMO’s would cover treatment at MD Anderson. Upon further investigation, I found that not a single available individual insurance plan in Texas would cover treatment at MD Anderson. It felt like getting sucker punched, and I cried out of anger and frustration, because my safety net was snatched away from me and I was in absolute disbelief they could do this. But they did, and they can, and that is absolutely, positively appalling. Someday we’ll get in to the exemptions I have to request for my follow up surgery to be performed at MD Anderson. That should be rich.
Here’s what I know: my monthly cost for this new HMO has increased , I have fewer options for doctors in my network, certain prescriptions will not be covered, prescription cost will be higher, and I have to see my primary care physician (PCP) to visit any specialist, although my PCP who I recently started seeing is not covered by this plan. On the upside, Texas Oncology (TO) and my medical oncologist in Austin, Dr. Yorio, are covered. Which is good, because they really are almost the only game in town. I believe it’s called a monopoly.
This last Thursday, December 31 at 4:30 in the evening, I received a call from Texas Oncology telling me my chemo on Monday, January 4th might not happen because with my new HMO I would need a referral from my PCP and prior authorization to continue treatment. This was lovely information to receive at the 11th hour, and more importantly I couldn’t believe that TO or BCBS would allow my treatment, and that of many others, to be interrupted in the middle of an established Plan of Care (POC). Matter of fact, it was so completely unfathomable that I proceeded to call BCBS and ask if this was true. The information I received during that phone call was that I would not need a physician referral or prior authorization to continue my treatment. When Texas Oncology called again on Sunday to say I probably wouldn’t receive treatment the following day, I told them what my insurance told me, and decided to go in to the office on Monday as if were all going to be fine.
I did, and it wasn’t. Apparently, BCBS had quoted me the out-of-network information. Here’s what blew my mind about TO, they had the option of proceeding with my chemo and retroactively billing for their services after I saw my PCP for the referral to get authorization. They chose not to exercise this option and instead interrupt a POC that they had established and is considered the gold standard in follow up chemo for my particular needs. They CHOSE not to administer my chemo. To simplify, they screwed up by not getting me this information in a timely manner, and my treatment schedule was affected because billing retroactively is a pain. I wasn’t the only patient in Texas who had this same issue. I also know for a fact now, that in the eyes of Texas Oncology and BCBS, I am not a human seeking assistance for a disease that is both physically and mentally exhausting, I am a unit of income, and that hurts my feelings. See, look Texas Oncology, you hurt the feelings of a cancer patient. Good one.
After letting them know I would be writing letters to the Joint Commission (the accrediting body for healthcare organizations in the United States) and Senator Kirk Watson regarding these matters, I proceeded to take care of business. First up, call the PCP that I had chosen from the list of approved providers provided by BCBS. Dr. Yorio sent her an email trying to get me in promptly, and after leaving his office I called the number BCBS had provided. The receptionist when I called informed me Dr. Buttrey hadn’t worked in their clinic for almost a year and had transferred to a community clinic that didn’t take insurance. Pardon? You must be mistaken. Please tell me you’re joking. She wasn’t joking. Dr. Buttrey was at that clinic part time, and the rest of her time she had switched to specializing in Dermatology. Even writing this, I feel as though my brain might burst. Pulling it together, because that is my only option, I called the Seton clinic where she had been previously and discussed my PCP options. Fortunately, they were able to make an appointment for the following day with a doctor who was both in network and a PCP. For the love of all that’s holy, can you imagine how many people had to do this? Shame on you BCBS, shame on you! However, Dr. Kerr saw me the next day, gave me my referral and her representative sat on hold with BCBS for 2 hours to get my authorization for a treatment I was in the middle of and had previously been approved by them. What a waste of resources and time.
In the end, my chemo was only delayed 2 days, which isn’t as bad as it could have been. But 2 days is 2 days. I’ve been doing this almost exclusively since May 2015. I’ve either been in treatment, preparing for treatment, or recovering from treatment for 8 months. Even 2 days is too much when I am so close to being past this. What if I wasn’t this proactive and it had been a week or more? Why would you do that to someone? I’ve done everything they asked and more. I am SO doing my part, and I am doing my part so well that I expect them to do theirs, too, and right now they are failing.
P.S. Hey, BCBS executives of Texas, sorry your salaries were flat last year, but maybe now you can have an increase from the millions of dollars you were paid in 2015, which obviously wasn’t enough. Someday, how about we have a sit down and discuss what “plenty” means, because you have plenty! More than plenty, you have lots, you greedy SOB’s, and you’re making it on the backs of the sick and those in need. There’s a special karma coming your way, and my only regret is that I probably won’t be there to see it.
P.P.S. I neglected to mention when I posted this earlier today that my gripe with Texas Oncology doesn’t pertain to my care. My doctor, the office staff, and clinicians who have helped me have all been excellent, and I thank them for their care. However, this seemed unnecessary and like bad policy, so I’m complaining.