Fun and games

Last week was all the medical things: MRI, appointment with liver surgeon, appointment with urology (the latter two mainly to be informed of all the things that could go wrong and sign consent forms), and then the full afternoon in Danville to be poked and prodded.

Pre-surgery physical, blood work, EKG, yadda yadda yadda. I continue to be disgustingly healthy, except for the obvious. I also got information about pre-surgery prep (much like colonoscopy prep), post-surgery care (not allowed to eat ANYTHING I LIKE for quite some time: no whole grains, no nuts, berries, vegetables, etc. I can have canned vegetables. [Blergh.] I will be living on poached eggs, white bread, and plain yogurt apparently. Fortunately that’s only for a few weeks, then I should be able to gradually start eating like myself again.

I will have a temporary ostomy, so one of the stops was to meet with an ostomy nurse, who explained the procedure (the science is so very cool!), the basics of ostomy care, let me play with the apparatus and then gave me the sample to take home. I very much like the ostomy nurse, and she agreed at the end that she was indeed going to go off and tell her colleagues about the entertaining patient who compared herself to a fistulated cow. (Biologists do not have the same sense of humor as regular people, nor do nurses.)

So that all went very well, and it was a nice day to drive to Danville (it’s a pretty drive in good weather), and we stopped for chocolate milkshakes on the way back.

And then I got home, and discovered a $67,289 bill for the radiation therapy my insurance company had approved before we started. Remember that? The fun of dealing with Federal BCBS to get my treatment declared medically necessary, and the three-week delay getting started? Apparently they changed their mind somewhere along the way and didn’t bother to tell me. And of course it was after business hours on Friday, so I gathered my paperwork and fussed all weekend.

This morning I called my contact (if you’re given a name and a direct number for an entity like this, SAVE IT). She was very nice again and explained what happened to me.

This is horrendously complicated…

There are two parts to the Federal BCBS, entirely separate entities apparently. One handles the professional claims, one handles the facilities claims. (I knew there were two addresses, but not how this worked.)

The professional side, the employer of my contact, deemed IMRT medically necessary and approved it. The facilities side did their own investigation and decided it wasn’t (just as the professional side originally did).

So the professional side is going to send all the documentation to the facilities side, which will presumably now cough up the money, or whatever small portion they can get away with paying.

My contact also tells me that the message at the bottom of my explanation of benefits is correct, and that the provider is contractually prohibited from billing me for the amount that insurance didn’t pay. Which kind of baffles me, but means I may not be liable for the $67k even though the provider billed me.

Except for slapping around insurance companies as necessary, I have the entire week free from medical anything. I feel great, and am hoping to sneak one (or two!) more kayaking trips in. I’m pretty well caught up at work, with a few exceptions, and have only a couple things to do at home, like mow the grass this weekend. Everything else can go hang.