The auth didn’t come through

How do I advocate for that?!?

Stuck: Is there a simple way to untangle myself?

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.