Cents & Sensibilities

It’s been a slightly difficult start to 2020. Toward the end of 2019, I spent hours on the phone with insurance, my primary, oncologist and doctor appointments fighting to get an MRI approved for my lower lumbar spine. Pleased as punch that I got my primary and oncologist working together as a team. It was a weight off my shoulders to have two exceptional doctors and a nurse advocating just as hard as I was to get it approved, especially during the holidays.

The good news is after being denied for the MRI twice by Cigna’s third party, my oncologist had a peer-to-peer discussion with them earlier this week. As of Thursday, January 2nd my MRI was approved. I was already organized and had rescheduled it two weeks ago for Tuesday, January 7th and will discuss the results and plan of action on Thursday, January 9th.

So, while I’m proud for advocating for myself along with my medical team, I’m still pretty pissed that I will be responsible for paying 80% toward my deductible since the MRI approval came on the 2nd. I truly do feel like Cigna did that on purpose so they wouldn’t have to pay because I had met my deductible and was $75 away from being covered 100% by the end of 2019.

It’s downright criminal that many of us must fight to receive the coverage and tests we deserve. Then we’re often stuck with huge bills that seem never ending.

A new year always brings added stress because of high insurance deductibles. Am I happy to have insurance through my employer? Of course, but it comes at a steep financial cost since I have to rotate between an MRI with contrast or an ultrasound every six months along with my diagnostic ultrasound + the cost of medications + copays to specialists. Me being me, I’m planning on fighting my portion of the MRI cost and file a complaint against the insurance. Sure, nothing will probably happen in my favor, but I must at least try for my piece of mind.

I do believe those pesky lesions on my spine are benign, but who knows what’s been growing there all this time since fighting with Cigna. Will they have to be burned off? Hell, if I know. Plus, will I have to get injections in the lower left side of my back to deal with this spondylitis? Will PT be part of the plan too?

All I see are dollar signs and scheduling conflicts as I move meetings at work to make it to appointments.

I’ve had people tell me to enjoy life, go on vacation and travel. I get so infuriated when I hear those suggestions. My insurance deductible through my employer is $6,500. How am I supposed to have fun and go anywhere or even save when that kind of cost looms over me? Getting critically ill is expensive and ongoing in the aftermath.

I want to go to different cancer conferences this year to meet more of the fabulous cancer warriors I’ve been talking to on social media but can’t take that kind of time off from work or have the extra funds since it all goes toward my high deductible. Yes, I know there are travel grants, but as I get older, I don’t qualify for some of those anymore. I’m at a weird age where I’m still “young” but not young enough to be eligible for some grants. Plus, I don’t have the energy to fill out applications once I get home from a very long day of working. I’m often mentally and physically spent.

As many look upon this new year as filled with possibilities, I’m already feeling the financial stress due to my health and the financial toxicity that is US healthcare.

14 thoughts on “Cents & Sensibilities

  1. You may have some luck by contacting the Insurance Security Commission. I also know if others who have requested a case manager through their insurance company who helps advocate for you.

    Liked by 1 person

  2. It is infuriating what insurance companies get away with in terms of denials and delay tactics. I’m truly sorry you and your doctors had to fight so hard for approval. Our system is such a failure for patients. Glad at least that you’ll be able to get the MRI and that your doctors teamed up on your behalf. Rooting for you!

    Liked by 1 person

  3. I find it difficult to understand how insurance providers deny medicine, procedures, tests, etc. when people are in pain. Pain doesn’t seem to have a price but the patient pays for it in many ways. I hope all goes smoothly on the 7th.

    Liked by 1 person

    1. Hi Kristie! Nearly had a darn heart attack when the imaging place said I had to pay $700 upfront. I negotiated down to $200 and payment plan for the rest…AFTER much stress and raised blood pressure. I almost canceled the appointment due to cost. Sigh.

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  4. I am glad you got your MRI approved! Hopefully you can file a complaint and get something in your favor. I totally feel you on this issue though. My deductible is $6850 with Cigna. With 2 young kids and still paying off medical bills from when I was first diagnosed.. it is daunting! I work full time, so don’t qualify for financial assistance. I am guaranteed to hit my deductible every year for the next 5 to 10 yrs.
    I am happy to be here for my kids and happy to have insurance but people don’t seem to realize all the extra that comes in the years after initial treatment.
    Xoxo

    Liked by 1 person

    1. Hi Tessa! I never thought surviving would break the bank. The injustice of it all truly angers me. I almost canceled the appointment tomorrow when they told me I needed to pay $700 up front. Though I negotiated down to $200, I’m so angry that I had to even have that conversation. It never ends. Gentle hugs.

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  5. File that appeal and then another without exhausting yourself mentally. Reach out to an advocate to help navigate. I for one can say I hate CIgna since they handled my ltd for my kidney disease. Years later they had to pay me back money due to being sued. My cousins wife just left them as an employee due to the stress.

    They know what they’re doing . Hoping they wear ya out before approving anything. It’s exhausting mentally, emotionally, and financially. I swear I’m going to research states with the best insurance options the older I get.

    Great article for a sad reason. No more is all I have to say- enough is enough!

    Liked by 1 person

    1. Hi Andrea, I did call the Insurance Commission this afternoon. There is nothing I can do on that side even though they acknowledged it IS unfair since all my requests came in December. She said technically they aren’t breaking the law. So, I will call Cigna directly later this week (going to FL for a funeral tomorrow thru Th) to file a complaint. I’m mentally spent. When the imaging place told me I must pay $700 up front, I nearly had a darn heart attack. I negotiated down to $200. I often wish I hadn’t survived due to cost to keep living. Definitely being hit by a wave of depression. Might be time to up my Lexapro.

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  6. I am so sorry you are having to go through this. The UK has its faults but the National Health Service (free to all) is a shining star I. This country! I do not understand how USA calls itself a civilised country and does not provide feee healthcare!

    Liked by 1 person

    1. Hi Jay! Preach dude!!! I just don’t understand how the US can spend billions and trillions of dollars on unnecessary wars and political crap but not help their own people, especially vets. The added financial stress has definitely played a part in my lack of healing well. I have another MRI in April. Sigh. Thanks for commenting from over the pond! Cheers

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