A breast cancer survivor shares her experiences with the BRCA gene.

Wednesday, October 22, 2008

The Hobby of Cancer Patients

People ask me how I spend my spare time. Well, while others are pursuing interests such as tennis or tango, I deal with insurance claims.

It's not the hobby I would have naturally chosen -- I was thinking more along the lines of painting classes or learning Greek -- but, since I was first diagnosed with cancer seven years ago, I have become preoccupied with resolving claims between my health insurance company and the provider - whether it's the doctor's office, hospital, lab, physical therapist, pharmacy...you name it.

First, I want to say that for the most part, I've been extremely impressed with my insurance company, Blue Cross/Blue Shield. Not only have they covered almost every claim, but they have also provided exceptional customer service. They have been pleasant and helpful...even going above and beyond to explain things and work through issues. Most of the time, it's been the physicians' offices who were unorganized and unprofessional...and down-right irritating at times. Of course, how many doctors do you know who went to business school? And yet, most of them are CEOs of their practices.

The cost associated with all my cancer has been staggering when you add it all up -- between the chemo and surgery and radiation (which I'm told is far more expensive than the previous two combined), the drugs and the billions of tests they put you through. The amount of money that has been spent on me could have paid off the debt of a third world country.

But now, I am stuck with a bill that I'm quite baffled about. I received a letter the other day from Myriad Labs, who stated that of the $3,000 for testing they conducted, my insurance company paid a little over $2,000 -- leaving me with the remaining balance of almost $1,000 -- even though BCBS had originally agreed to covering it in full.

When I called BCBS, my customer service rep explained to me that because Myriad was "out of network" for my policy, they would only cover 100% if it was an in-network lab. But, Myriad is the ONLY lab in the U.S. that conducts this test -- so I had NO choice in the matter. They were the only option for me to learn I had the BRCA gene, I pointed out.

Doesn't matter, I was told.

I don't get it. BCBS covered all my surgery -- plus, all the tests, doctors' visits, medications, etc -- because I was a breast cancer survivor & BRCA gene carrier and, yet, they won't pay for the lab that found I was a BRCA gene carrier in the first place.

Go figure.

I learned this after being on the phone for 30 minutes with BCBS today. My next step is filing an appeal and stating my case as to why they should cover this cost in full. Another day, another phone call.

Maybe one day, I'll have time to learn how to knit.


Anonymous said...

As long as you give your good faith effort to have BC/BS pay, Myriad should honor what the originally told you (that your expected out-of-pocket was nil). If needed, Myriad will also help with a payment plan.

Anonymous said...

I agree with the previous comment. If Myriad reported that you had no out-of-pocket expense, they should honor that and foot the remaining bill. Speak with your genetic counselor, they may be able to help.