Success At Last

Success at Last
Yesterday was chemo day—actually that would be two days ago since it is 2 AM as I write this. Thursday was a very successful day. Josh and I were out of the house on time for a change, and I even had time to shower, wash and style my hair and put makeup on before we left. We stopped at VITA Administration in Mountain View to drop off my first COBRA check so that the pharmacy portion would be reinstated prior to my chemotherapy appointment. Thanks to help from Laura Gothic in human resources, the cancellation of my health insurance was reversed within 48 hours of my phone call to the benefits office. I arrived a bit early to the ITA (infusion treatment area) to have my blood drawn and then met with Bea Bravo, my oncology social worker, who is helping with the rest of my benefits that have been cancelled. We went over my list of questions for the benefits office. When I tried to ask my questions prior to the time my benefits were due to be cancelled, I was told I would have to submit any questions in writing first and the benefits office would then respond to my list of questions. They did not promise to answer the questions, just to respond to the list. Bea suggested she review the list first to be sure I did not omit any areas that might be important or come up later. We were just getting around to doing that because of time constraints and the fact that I have felt so rotten the past couple of weeks. I took notes on her comments and revised the list. I called Laura on Friday to verify her email address so I could send her the list of questions. She told me a benefits specialist named Monique had been assigned to me and that I should submit the questions to her. Monique was to call me on Friday or Monday. I emphasized to Laura that the clock is running on converting my supplemental life insurance. I know that my portion of the premium is $91.77 per month, but I will have to pick up the Stanford portion of the premium as well. I do not know what that amount is.
On Friday, I received an acknowledgement in the mail of the check I dropped off on Thursday and enclosing 18 envelopes and payment coupons for my 18 months of COBRA coverage. By the end of that time, I should be eligible for Medicare. The ominous cover letter contains several warnings: the premium can be changed at any time and VITA may not notify me in time to change the amount of my monthly payment; that if I am late in a payment my COBRA will be cancelled permanently and nothing can be done to reinstate it; and payments are due on the first of the month. I am paying $617/month for my health and dental insurance. That is 7404/year. It seems like quite a lot, but the expense of not having insurance is far worse. I will have to be very good at budgeting things, but I think this can be done.
Also on Friday, I received my first social security check. There was no explanation of the benefit amount and I was told by the paralegal at the disability law firm that I was approved for $2012/month. This check was for $1500 so we are guessing the law firm got their 25% of the first check fee. They did absolutely nothing to deserve this fee as I ended up doing all the work. This included calling them all the time to ask what they had done. All of my requests for a written documentation of the work done were ignored. They promised to send it and never did. This included my most recent request for documentation of work performed by any member of their law firm. I tried to file a complaint with the state bar association, but was told I do not even have enough information to do this as I was always passed off to a paralegal and never spoke to any attorney in the firm. The bar associate I spoke to insisted there had to be a lawyer working on my case because it is illegal for a paralegal to handle the case alone. If there was an attorney, I never had his/her name, never spoke to him/her on the phone, and never received any correspondence signed by anyone other than a paralegal. In addition, this firm of 60 attorneys has only one fax line so it was impossible to send a fax during normal business hours. This seems like malpractice to me. To tell a client to fax something to you without mentioning that you will likely get a busy signal for hours, is at the very least extremely rude. Add to it the fact that your entire client list consists of people who are permanently disabled and may not be physically capable of staying next to a fax machine for hours just to hit the redial key every time amounts to intentional infliction of physical and emotional distress. Josh feels I should just let it go. The firm got $500, which he feels, is a lot less than they expected. We also felt the first check was going to be larger since we applied for benefits in August 2008. Evidently, there is a 5-month waiting period to receive benefits. My first check is for the month of March. Social Security deducts the amount of my state disability from the federal award until the end of 12 months, at which time my state disability benefits end.
Finally, Friday’s mail brought the great news that my insurance company has approved the $30,000 statement I received from Stanford for payment. That was when I did not know Stanford cancelled my health insurance and I went into the ITA for a blood transfusion, fluids, anti-nausea meds and electrolyte replacements.
One more thing that could be considered a plus for a day of mail---I did not receive any bills to be paid! There was cute card from the Toolbox team with individual notes enclosed from everyone who attended the meeting. I wish I was well enough to travel to San Antonio for the meeting, but I am now trying to get strong enough to travel to Gabby’s opera and then NJ and San Antonio. Tina told me yesterday that she is going to come to San Antonio with Josh and me. She cannot stay the entire time we are in San Antonio but she can help with the flight there and help take care of me, which will give Josh more time to do his schoolwork. Also found out the hotel where we are staying has a spa and if my platelet count is high enough, I want to have a massage while we are there.

The Cobra

Have you ever asked yourself why the COBRA process bears the name of a poisonous snake?

When I was first diagnosed with breast cancer in 2005, I had to be off work for a total of 10 months due to surgeries, chemotherapy and complications such as autonomic neuropathy, congestive heart failure and a couple of falls that resulted in at least one concussion. I got sepsis from an insect bite that resulted in a 30-day hospital admission. It was during one of these admissions that I discovered I no longer had any health insurance. I was being discharged from the step down intensive care unit and my friend Patrice was going to drive me home. We stopped at the pharmacy in the Cancer Center to pick up my discharge prescriptions. I waited in the car while Patrice ran in to pick up the medications that would keep me out of congestive heart failure in the future. She was gone a long time and I was beginning to wonder if there was a problem. With my luck, of course there was a problem. According to the Walgreen’s computer, I no longer had any health insurance. There had been no notice from my employer – the very hospital from which I had just been released. There was no opportunity to pay premiums to continue my health coverage. In fact, the coverage was terminated during my stay in the intensive care unit. To say that I was upset would be a gross understatement of the feelings that were running through me.
This situation led to quite a hilarious scene in the admitting department the following week. I was scheduled for a follow up test, called a tilt table exam, to learn why I kept dropping my blood pressure and passing out. A friend was driving me to that appointment and we ran into the same difficulty Patrice and I had encountered at Walgreen’s pharmacy. The computer had not reinstated my benefits and I was uninsured. In order to have the test, I had to sign a paper stating that I agreed to be financially responsible for the cost of the tilt table exam. I signed and then started to walk out of admitting toward the ambulatory treatment area where the test was scheduled to take place. Suddenly I could not see anything, although I could hear people around me saying things like, “What’s wrong with her?” The next thing I knew, I was lying on the floor, Tom was holding my head away from the floor and I could hear the overhead page for a code blue in admitting. I looked up at the admitting clerk and told him that if the code was being called for me, he should call the switchboard and cancel it. He told me that was not possible because I had lost consciousness in his admitting department and he was not qualified to evaluate me medically and make a determination that I would not do it again. [If you feel like laughing here, it’s okay. I also felt the absurdity of the situation.] I could see the nursing supervisor and some of the house staff running toward me with the crash cart. From my experience working in the hospital and from what patients had told me after receiving their bill, I knew that if the lock on the crash cart was broken, there was a $1,000 fee to inventory and re-stock it with the equipment needed for the next time it was used. I had just signed a paper saying I was going to be financially responsible for any costs incurred while I was in the hospital that day. I did not want to pay $1,000 when I knew that I had not had a cardiac arrest. I knew I had just dropped my blood pressure and that the simple act of lying flat on the ground had probably restored it enough that I could proceed on my way to the tilt table test. So I did what any impoverished patient would do under the circumstances. I started yelling down the hall to the nursing supervisor --- “Gretchen!!! Don’t break the lock on the crash cart! I can’t afford it!” the people in the admitting area probably thought I was insane, but I did not care. Money is money and I could think of a lot of things I would rather spend $1,000 on. My poor friend Tom, who was kind enough to prevent me from smacking my head on the floor, was shocked. Having seen me pass out, he was in favor of opening the crash cart and doing whatever was necessary to make sure I did not pass out again until he had safely escorted me home. He looked a little panic-stricken while all of this was going on.
When Gretchen and the team of doctors and nurses reached me, I explained to them the reason for my visit to the hospital that day. We all agreed that the test was moot at that point because I had just demonstrated that my problem was related to my blood pressure and not my heart function. The crash cart remained intact and Gretchen escorted me to the ambulatory treatment area, where the tilt table confirmed I could not maintain my blood pressure when going from a sitting position to standing upright. I have been on a medication to raise my blood pressure since that time.
When I recovered enough to return to work, I called the CEO of the hospital and asked for an appointment to discuss my experiences as a patient in the institution where I work. At the top of my list of items to discuss was the lack of any notification when the hospital cancelled my health insurance benefits. Martha Marsh, our CEO, and the chief of staff at the time Dr. Jerry Shifrin, took careful notes. About a year later they announced plans to completely overhaul the human resources and benefits offices to make them more user-friendly. That process took more than two years and just a few months ago I read in the weekly E-news for the hospital that the new benefits office was announcing its services. I thought this was great news. Little did I know that history was about to repeat itself.
Fast forward to March 3, 2009. My local Walgreen’s pharmacy called to say they were having difficulty refilling one of my prescriptions. Each time they tried to process the refill, the computer told them I had no health insurance. I knew that my benefits had expired on February 28, 2009 but I received a packet of forms to complete on February 20 and returned them to the (new) benefits office on February 26 after having the employer, employee and physician sections completed and signed. The company that is charged with providing information about COBRA (continuation of benefits) has not sent me any information on the cost of continuing my health insurance, disability insurance and life insurance. On Thursday I am scheduled to receive chemotherapy at a cost of $14,000. I am NOT willing to sign an acknowledgement of financial responsibility for this amount. In three years, I have learned a thing or two. One of them is that I have met all of my obligations and it is now up to the hospital to meet their responsibility by at the very least, providing me with the information I need to decide whether I can even afford to continue my benefits. So, I spent much of the day today doing some research on the cost of insurance, when I become eligible for Medicare benefits under my social security disability claim, and who in the benefits office knew enough to help me get my insurance reinstated before my chemotherapy on Thursday. All in all, it was a fairly successful day.
Thanks to Laura in the benefits office, VITA has emailed me the documents I need to complete to continue my medical, dental and pharmacy benefits. The rest of the package can wait until after chemotherapy on Thursday. I need to make sure I can get my prescriptions filled and that I will not be personally charged for the chemotherapy drugs. I think it would be adding insult to injury to make me pay for drugs that make me feel sick for at least a week after taking them. The cost to continue my benefits is actually less than it was three years ago. This time around, it will be $620 per month for the medical part of the package. I still need to find out how much it will cost me for the life insurance package and the short and long-term disability policies I have. Whatever those cost, I will definitely continue them because the disability policies provide me with an income and there is no way I can get life insurance except through my group plan at work.
If I ever need to go back to work, I have a great idea for a business. It is not a stress free business by any means, but I know that I would pay someone else to deal with the insurance companies and the benefits office for me. I am sure there are many patients out there who feel the same way I do. It is worth whatever it might cost to get someone else to deal with the bureaucracy of insurance companies. I am good at making friends over the phone. When I was the triage nurse for the cancer center, I used to set up admissions for patients in crisis so that they would not have to wait hours in the emergency department. I learned who the key people were who could make the system move under duress. It was to both our advantages to help patients move through the system with a minimum amount of hassle. I even got social security to approve my claim the same day they looked at it. It just took them 7 months to decide to look at it. The idea for this business is not unique. I am sure there are other people who have the same idea or a similar idea and have made a career of it. I will keep this as a back up plan--- way, back on the list of things I could do to support myself while unable to work in my chosen career.
Do you still wonder why the COBRA process bears the name of a poisonous snake?