Most of you have heard by now that we lost our appeal with Scott and White Health Plan on Friday. Last week was so emotionally depleting that Saturday’s Fed Ex letter explaining that the “unbiased” panel (made up of three people affiliated with Scott and White Health Plan) had sided with Scott and White’s original decision to provide out-of-network coverage for the surgery and pre-op work at MD Anderson Cancer Center. Surprise. Surprise.
If you are wondering why out-of-network benefits don’t help me, click here.
We were not surprised and God certainly was not surprised. Our week was a roller coaster anyway and ending it with this appeals process being totally over was a welcome relief but my emotions and body cratered. I am exhausted, having pain and just feeling cruddy in general. **sigh** I was really feeling energetic and great until Friday afternoon but I suppose, this too shall pass.
Let me set the
kangaroo court stage for you.
We drive to the Scott and White office. We wait in their waiting room until we are ushered by them into their conference room where seven people invited by Scott and White all eagerly wait to look us over and hear our story. The “unbiased” three person panel who would act as the jury was composed of a Scott and White customer service employee who get a paycheck from Scott and White, a surgeon who works at and receives a paycheck from Scott and White and a health plan enrollee who receives a paycheck from one of Scott and White’s largest corporate members.
Are you getting the picture?
I wish I could tell you everything about the hearing. You would all sit with your mouths hanging open in disbelief. We went into the hearing with a strong factual case, according to our attorney. We came out with what our attorney says is a strong case which he has offered to litigate for us. We are contemplating prayerfully our next step. So, I cannot share with you the bizarre turn of events that transpired. But what I can tell you is that we all, my husband, brother-in-law and myself, saw God’s hand in getting me to MD Anderson.
Many of you are also wondering how I will get the treatment I need to live. Many of you have sent some invaluable information. Actually, the advocates at MD Anderson have been our most effective resource in receiving the means to treatment. After our first call to MD Anderson, Tamara told us exactly what we needed from Scott and White. After only a couple of days it became apparent that we were going to be unable to obtain the proper requirements from Scott and White to receive any diagnostics or treatment at MDACC. We were understandably heartbroken, scared and already floundering from a devastating rare cancer diagnosis. Scott and White was completely unhelpful in offering us alternatives for treatment as I was referred repeatedly to general surgeons but no surgical oncologists who specialize in sarcoma. (There aren’t any in the Brazos Valley.)
In an effort to acquire information and resources to get to MDACC, we turned to Tamara our patient advocate at MDACC. She gave us a list of state agencies who could help us out of our predicament. She recommended we call our state representatives and local congressmen. Fred Brown our state rep was ultimately responsible for getting my surgery rescheduled after Scott and White nixed it. Chet Edwards’ office told me they don’t help people in my position.
We called the Texas State Insurance Board immediately. They are a state legal agency who mediates disputes between insurance companies and their patients. We will file yet another formal complaint with them against Scott and White.
We called The Texas Insurance Risk Pool. This is a state agency set up to insure people with uninsurable diseases who are not covered because their insurance company denies them, their benefits aren’t good enough or they have no insurance at the time of diagnosis and need extra help besides Medicare.
I was accepted into the pool shortly after my surgery but have to wait until my Scott and White policy has been terminated before my benefits will start. Unfortunately with Scott and White that is the end of the current month in which you cancel. I found out the first week in March that I needed to cancel. Thus, the thirty-day wait began.
So, in answer to your question, I am purchasing an insurance policy through the state to receive coverage as a patient at MD Anderson Cancer Center in Houston. This is how MDACC suggested I obtain coverage and we are hoping and praying it will all work out really well. I will spend the next few days learning a new plan and working out all the kinks. Say a prayer it goes smoothly.
As for the rest of our family, God has so graciously provided a way for all of them to get out of the clutches of the Scott and White Health Plan also. Because heaven forbid I would ever have to go through this with one of them. I just couldn’t. I’m so sorry to lose our awesome Dr. Wagner and team but so relieved to know we will have great care at facilities adequately equipped to handle rare conditions should the need arise.
Now, I’m not naïve. I know that I will still have an insurance battle, it will probably be a different one and many of you have battled Blue Cross and Blue Shield on other matters. But, MDACC says this is the best way for now and God has opened all the doors. Our state rep, Fred Brown assures us that because this is an insurance plan funded by state dollars that he will lots of sway over my care. We won’t hesitate to let him know how he can help and we won’t hesitate to thank him at the polls in our local runoff April 13.
That is a ton of information but I wanted to be specific in case it can help anyone. And, just typing about it has left me t.i.r.e.d. I will post more this week about other turns of events from last week. It’s sure to be exciting…From a song of my youth...one of God's promises, "The Lord says, “I will guide you along the best pathway for your life. I will advise you and watch over you." Palm 32:8Walking the best path,