Well, made it through the week with only two additional calls from either my insurer or MD Anderson to rub salt into a wound.
All I can say about their practices is that if I, someone with resources and a case that’s serious but not really dire in the sense of needing the applied wizardry that MD Anderson’s doctors are good for, get this kind of treatment, it’s just something enraging, but it’s not going to significantly impact my ultimate outcome. I can do Plan A.5. I’ll keep going, a little sadder at the state of the system, a little angrier at how it impacts people with less rope to hold onto than I have, but I will keep going.
But imagine being someone with a weird and aggressive brain tumor – and there’s a doc at MDA who’s cracked its code. Your oncologist gives you a referral, and your clinic system approves it, but your insurer denies the facilities approval for MDA. And while you’re processing that, someone from your insurer calls and dangles a little glimmer of hope in front of you… so they can just yank it away again. Then the next day, someone from MDA calls to see if you want to “close your account” that never had any charges on it because without the insurance approval, you can’t get past MDA’s Financial Clearance Center to even *schedule* an appointment with their doc.
Sure, you can appeal, but that process, even when requesting “expedited” review, can take weeks or months, which you don’t have to spare waiting for approval.
The possible fix is there. You can see the building it’s in from your doctor’s office, but you can’t get through the door unless either your insurance reverses itself and approves it, or you pony up tens of thousands of dollars up front. Or somehow qualify for a clinical trial (I read up on the ones MDA is doing for colo-rectal cancer. They’re incredibly specific in what kind of person they want – “East Asian female between 20 and 25 years old with both of these two specific genetic markers who has not yet received any treatment for cancer of the ascending colon” is something I made up, but consistent with the kind of descriptors going with these studies. Needless to say, not many people qualify).
Sure, I’d cash out my IRA to save my life. Or at least try: I’m quite positive I don’t have enough in that account to cover even the standard treatment I’ve received to date. A single chemo infusion with FOLFOX is $28,000. I’ve had 6 (so, $168,000). My two hospitalizations so far total well north of $100,000. The ambulance ride was over $6000. The anesthesiologist had charges. I’ve had 4 CT scans that run about $3800 apiece ($16,400 total). And a lot of specialist appointments. Oh, and one of the antibiotics I was prescribed was north of $2400 for 6 pills. The genomic workup that gave us assurance that my cancer is normal and treatable and I don’t have the markers for the nasty recurring kind was $28,000ish. If I’d had to pay cash for all that, I’d be somewhere in the low six figures in debt after exhausting my IRA (and paying taxes on it), and I’m about 40-45% through my treatment, assuming I don’t need a third set of chemo infusions (top tip: don’t make that assumption).
Again, my treatment, aside from the ongoing secondary infection issues, is stone conventional. I don’t need experimental treatment. I don’t need clinical trials. So I can stay within my network and get quality treatment covered (aside from copays) by my insurance. Hell, I might even hit the OOP max this year ($7320). Oh, wait, I won’t. I was 5 dollars short ($4995) in 2017, not that I got any bills aside from some minor copays in 2017. All the big ticket stuff billed me in 2018. And doesn’t count against 2018’s OOP max.
So, yeah, especially for my readers not in the United States, our system is severely borked compared to the single-payer systems used elsewhere.
But hey, there’s some good news! There’s a blood marker for colon cancer called “CEA” on reports (do not ask me to expand that acronym, ’cause I can’t). The “normal” range is 0-4.7 units. In December, I was at 71.1 units. In April after chemo ended, I was at 3.0 units. Tuesday, I was at 2.8 units. Per the oncologist, this means my cancer isn’t getting aggro in my too-long layoff from chemo. It’s still *there*, of course, but it’s not growing aggressively. This is consistent with what they told me at the start, that it’d probably been growing 2-3 years before it became a noticeable problem.
So that’s good.
Now, for the FAQ:
Enough people have asked why I don’t just apply for Medicaid to cover all this. Several anecdotal stories from states other than Texas about full coverage, etc.
Well, I’m glad that worked. ‘Cause it won’t work here.
Medicaid, for those who don’t know, is a federally-funded medical care program for low- and no-income people. But while it’s federally-funded, it’s up to each individual state to administer those funds within their state. So there’s 50 different sets of rules for Medicaid.
And in Texas, where we have a state government firmly committed to making sure no brown, black, or female people get any sort of “leg up” to help them climb out of poverty (which is, of course, due to laziness, not circumstances of birth, medical problems, education, minimum wage too low to be livable, or any of the real reasons people are poor), the rules for being accepted to Medicaid are pretty stringent, and then you have more rules to abide by to not get kicked off it (note also that Texas refused the ACA-related Medicaid expansion dollars because accepting them would mean having to cover birth control. Not abortion. Birth control. So they passed up tens of millions of dollars annually because the old “Christian” white men in suits running the show — and yes, this includes the people who vote for them — think sex should be for procreation only).
So, I made too much money in 2017 to qualify for Medicaid in 2018. And I’ve already made too much money in 2018 to qualify for Medicaid in 2019 – even missing basically 4 months of work entirely and only being part time since May. (Recall that I don’t get paid if I don’t work.)
And I have private insurance. Which I’d have to drop to qualify for Medicaid. This, by itself, is problematic for reasons that should be very very obvious.
And one that’s less obvious: if I stay on my insurance plan, even if Texas AG Ken Paxton (who is still under indictment for securities fraud, mind you) is successful in getting the ACA’s preexisting condition coverage provisions overturned in the courts, I’m still covered. But if I drop my coverage and Paxton wins out, it’s going to be totally impossible for me to get new private insurance coverage unless I first get a job at a sufficiently large corporation that can force an insurer’s hand under the employer’s group plan. And of course, the number of sufficiently large corporations willing to hire someone actively undergoing cancer treatment and unable to work full-time is a number I can count on the fingers of no hands. And the number of sufficiently large corporations who would extend benefits to someone who can only work part time under irregular hours is an even smaller number (we’re getting into quantum levels of zero here).
So, to qualify for Medicaid in Texas, I’d have to stop working now and not work at all in 2019, and drop my private health insurance. And then I might qualify for Medicaid in 2020. Or the state may change the rules again and I don’t qualify.
This is not a game I’m willing to play. It’s Russian Roulette with 5 rounds in the cylinder.
So, I’m going to keep working as I can, and keep my private health insurance, even though 2019 is looking like another big premium jump thanks to the GOP-led Congress and the “all hat, no cattle” guy in the White House.
And now you know.