One day last summer as I sat down in my assigned area of the infusion room, I noticed a patient sitting opposite me. She was not in the fancy chair with the IV stand, and she seemed upset. A nurse approached her and said:
The auth didn’t come through, but we’re going to work on this and figure it out. Don’t worry.
I had been cleared that day for my infusion and was relieved for me but horrified that this could happen. What a nightmare. I need to do what it takes so I don’t have a lapse in my plan, I told myself. I might have been a bit smug.
Something similar happened to me today: insurance hadn’t authorized my 8th infusion, and I was sent home.
This didn’t occur completely out of the blue:
Insurance mailed me — in June — the authorization for the series; this authorization was valid for 180 days and would expire in December
I remembered that piece of paper and brought it to my November infusion to make sure the Dr’s office was aware
The Dr’s scheduler alerted me yesterday that authorization was still processing and I might not receive the treatment the next day — I should still come in for blood work
During the visit with the nurse practitioner today, my online chart showed that I was cleared for the treatment. Great! When I was in the infusion waiting area, plans changed yet again. An exceptionally kind infusion nurse sat down next to me:
Auth didn’t come through. I’m so sorry. I’ve been watching this since yesterday. Insurance said it should be cleared by end of day but that’s too late for today, so we’ll need to reschedule next week.
Everyone who has health insurance has stories of coverage being denied. In my before-cancer time, I liked to reassure myself that as long as I wasn’t going in for a nose job, my insurance plan would cover my care. How naive I was.
This is what I’ve had to fight for this year: MRI, PET scan 1, PET scan 2, prescription drugs. And today’s immunotherapy.
Appealing these decisions typically involves numerous phone calls, submitting supporting documentation, and filing (and refiling) claim forms. When time is of the essence, and I want to move forward with an unauthorized procedure, I will pay for it myself — within reason — and cross my fingers that insurance will reimburse me.
I’ll wait for the authorization for the immunotherapy, and I’ll get over today’s hiccup. But I am mad and disheartened at a system that seems to treat patients as an afterthought instead of the reason for being.
It is pure corporate greed. How much profit have insurance companies raked in over your lifetime? How can this be fair? 🤬
This is our broken medical system where giant insurance bureaucracies are never held accountable. I believe it is the reason we will never have a national healthcare system. Now it feels so personal. I’m so mad you had to endure this extra stress.