Christmas Present

It's Christmas Eve and I just received a wonderful and unexpected gift!

It didn't come wrapped underneath my tree, but rather, in a voice message.

Blue Cross Blue Shield of Georgia called and let me know they were, in fact, going to cover my bill for genetic testing IN FULL!

Thank you, Blue Cross Blue Shield!

Yes, Virginia, there are caring health insurers after all!

Resolution! (other than the New Year's kind)

It's almost Christmas and I've encountered an angel. It's true!

Myriad Labs resolved my bill--they adjusted my balance to zero! Zip! Nothing!

Dear Ms Auton,

Thank you for your assistance in the appeal process. However, Myriad will stand by the quote that Blue Cross Blue Shield of GA gave us prior to the test. In your case, they quoted 100% coverage. If they do in fact deny your appeal, please forward that denial to Myriad and your account will be adjusted to $0.

If you have further questions, please don't hesitate to ask.

Sincerely, Patient Accounts
Myriad Genetic Laboratories

It's time like these in which you want to reach through the phone and kiss somebody!

So, my advice for all you breast cancer survivors whom I've been encouraging to get genetic testing: Make sure you get IN WRITING your insurance company's commitment to pay 100% of the service rendered.

Get it documented. Save the documentation. Get it signed in blood...that's what it takes for insurance companies to honor their word these days.

I've been told that insurers bank on most of us not challenging and fighting their lack of coverage. They figure we're too overwhelmed with other things...like our health.

Although it takes precious moments out of your life, staying on top of insurance companies' payments is critical. I've already spent thousands of dollars out of pocket on cancer, when I could have been vacationing in Alcapulco.

I told Myriad that although they erased my bill, I would continue pursuing payment from BCBS. It's only right that I help. Therefore, BCBS has not heard the last from me.

My next step is taking this to our HR benefits person, since we just renewed our BCBS contract for 2009. What BCBS doesn't know is that my company has a personal interest in breast cancer, and BRCA testing--since we're mostly female employees and the majority of our customers are women, as well.

Just like John Paul Jones, I have just begun to fight!

Take That!

It's not even New Year's, and I've already broken one of my New Year's resolutions. (#3--Show grace and kindness to everyone.)

I was less than gracious to the insurance company's customer service reps, who put me on hold for infinity, and found myriad (as in Myriad Lab) excuses as to why they couldn't and wouldn't pay my bill in full.

My friend, Pam, told me (as I was venting during our walk) that I needed to add a disclaimer to my "be nice to the world" resolution--exempting anyone who is "petty/vile/self-centered/manipulative."

That category needs to be dealt with swiftly and forcefully, without a trace of charm and sweetness. No siree.

If I had only known about the "disclaimer rule," I could have kept all my previous resolutions in years' past.

Memo to Myriad

My new best friend, Erica, the genetics counselor, read my blog entry and noted my frustration.

Her advice: Talk to Myriad! She said they dealt with this sort of slimy insurance thing all the time. (My word, "slimy," not hers.)

So, I dashed off a memo to Myriad...

To Whom It May Concern: Attached is the correspondence I received from Blue Cross Blue Shield of Georgia, denying my appeal.

I talked with a BCBS customer rep, who told me that you have to produce evidence that they agreed to pay 100%. She said that although they authorized paying the “billed amount for the services,” this apparently does not necessarily mean they will pay 100% unless you have a separate document saying so.

This must be insurance lingo, because “paying the billed amount” = 100% to my way of rational thinking.

Therefore, I wanted to see if you, indeed, have yet another document that states you received authorization from BCBS to receive 100% payment.

Thank you for looking into this matter.

The Case of the Missing Authorization

I've suddenly become Nancy Drew...tracking down the mysterious document, authorizing 100% coverage.

What would Nancy do? She'd jump on the case immediately. Contact the genetics lab. Contact the genetics counselor.

And friends wonder why I don't return their calls in a timely fashion. As Nancy would tell you, there's no time for chit chat, when you're hot on a case.

When Insurance Doesn't Pay (as Promised)

So, here I am, sitting on eternal hold with my health insurance company, BlueCross BlueShield of Georgia, and listening to the taped message featuring cheesey Christmas music and a perky woman's voice letting customers know how much BCBS cares about us and is there to help. Hmmmm...

"We're looking forward to assisting you!" I'm not sure they want to hear from me today.

I just received a letter from BCBS stating they were denying my appeal to fully cover genetic testing at Myriad Labs--to the tune of $1,000--even though I had produced a letter on BCBS letterhead and signed by William Tatum, MD, Medical Management, BCBS: "We have approved your request to receive care as described above."

Yet, now, BCBS will not accept this document. Go figure.

I've been speaking with Veronica in customer service, who can't answer my question of why I've been denied coverage when I have a letter in-hand stating otherwise. Because Veronica is perplexed, she puts me on hold to find a supervisor.

10 minutes later..."Your call will be answered shortly! Thank you for holding!"

My plan of action, therefore, is to get tough. I'll stay on hold all day, if need be. I'll take this to the top of the insurance company. I'll write an editorial. I'll call every day. I will get this resolved.

20 minutes later..."We do respect your time! Please continue to hold. We will be with you as soon as possible."

It's amazing what you learn when you've been put on hold with your health insurer. I now won't eat too many sweets during the holidays due to diabetes risk...Cold season is here, and antibiotics are not an effective treatment since colds are caused by viruses--rather, drink plenty of fluids, get rest and use an over-the counter cold medicine, if needed...Several ways to reduce getting the flu include wash my hands and cover my mouth/nose when coughing; avoid people with flu-like symptoms; stay home if I don't feel well...Wearing heavy backpacks may injure your child's spine. Limit loads to 10-20% of your child's body weight....Keep fitness goals during the holidays by playing holiday music while working out!

30 minutes later..."We hope the New Year brings happiness and health!"

I'm wondering if they are starting to forget about me. Maybe this is another tactic to avoid paying -- keep me on hold forever so they'll never have to address my proof of a signed document by them.

At this point, I've been on hold for over a half hour and I've heard the recording about the cold season for the 50th time; therefore, I think I shall call them back...

My next call produces Mindy in customer service. She reviewed my information and said that although BCBS agreed to pay for the billed amount of the services, unless there was prior authorization saying they would pay 100%, they would only pay 70%.

Am I missing something here?! They agreed to cover the billed amount on my document, and now they are telling me that I needed to have some additional, special authorization for them to cover 100%. Of course, neither the lab nor I were aware of this. Somehow, I figured "paying the full bill" meant "100%", but then again, I don't know insurance lingo.

Mindy puts me on hold again, and I'm thrust back to "Deck the Halls" and "We appreciate you holding" message while she seeks further information.

I've now been on the phone with her for 15 minutes (for a grand total of 45 minutes)...

Mindy returns and, yep, I not only missed my appeals window of 180 days from the claim (in February)--although I didn't hear the first word about it until October (doesn't matter, said Mindy)...but also, the document I have in hand that states full coverage is negated by the fact that apparently I don't have yet another document saying they will pay 100% coverage.

Consequently, I must go back to my genetics counselor and the genetics lab to see if they can produce the required additional authorization.

No problem. I had nothing better to do anyway today.

2009 Resolutions

New Year's is a little over 2 weeks away, so I've been thinking about next year and what tweaks and adjustments I want to make.

There's something about turning 50 this year--coupled with being a BRCA-carrying, two-time cancer survivor with a recent MRI exposing a "suspicious spot" on my leg bone--which makes me think seriously about how my days are numbered. I realize that I've not only lived over half my life at this point, but, also, that I can't necessarily count on living a long life since I've battled cancer twice. Yes, I'm aware that none of us knows how long we have, but cancer makes you more aware of this little fact.

So, peering into 2009 and beyond, here's what I want for my life:

ONE. I want every day to matter; every interaction with others to matter. I don't have time to waste. A day to waste. A relationship with another human being to waste. I want every moment to be lived, every connection with another person to bring life and meaning. This means changing my Tasmanian Devil-like behavior in which I buzz through life in a whirlwind of activity.

I've been thinking about this a lot lately. Take last weekend, for example. On Saturday morning, we had a security system installed. It was supposed to take only a couple of hours, but I happened to ask the young guy installing the system about his family, and as a result, my husband and I ended up doing marriage counseling with the installer for over an hour. It threw us off our schedule for the rest of the day, but he seemed so eager, so desperate, for advice.

After he left, I rushed off to visit with a former coworker, who had almost died this past year from complications from cancer surgery. Instead of my usual Saturday of errands and chores, I simply focused on spending time with her. And, it was time well spent. We reflected on where we've been with cancer and how life is precious--sharing in a way that only people who've been to hell and back can relate.

On Sunday, we baked Christmas cookies with two teenage brothers (yes--teenagers!) because for some odd reason, we are considered cool and hip enough for them to want to hang out with us. Two teenage guys=flour and cookie dough all over the kitchen floor and every utensil used. Yet, despite the mess that had to be cleaned up, I loved the laughter and they loved the attention.

As I reflect on this past weekend, I didn't accomplish a lot in terms of house & yard projects. Yet, I feel like I connected in a powerful way with others. And that makes me think that my life counts. That I can provide love and hope and joy to others, and that's really all I want for my life.

TWO. I want to stop living in fear. In addition to the economic calamity that pervades everyone's life at the moment, I'm scared that cancer will be discovered in me again and my life will be cut short. And, at the same time, I'm sick of worrying

I want to walk into the future with courage...accepting whatever comes my way. Dealing with life's challenges with power, rather than being the helpless victim. I'm tired of being the scared little mouse, scurrying to hide in a hole somewhere. I want to face life head-on. Of course, that doesn't mean that I won't have my meltdowns, pity parties and moments of angst. But after that, I want to get up, dust myself off, and move forward with boldness...tackling what life has in store for me.

THREE. I want to extend grace to others, being more forgiving and patient, more giving and kind--which will be a major challenge, since I'm often gnashing my teeth in frustration with the world in general. But, so many people have forgiven me for my mishaps and offenses, and extended grace and love and kindness when I needed it most...and I realize what a gift that is.

So, these are my goals for 2009 -- to embrace life more fully and powerfully than ever before, knowing that each day counts. To live with purpose and not waste a day with childish attitudes and ridiculous actions.

Other than these goals, the only other thing I want for 2009 is a great dye job. After all, if you're going to have a new boob job, you have to have great hair.