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Sunday, March 28, 2010

Verdict's In

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 na├»ve. 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 32:8

Walking the best path,

31 comments:

Missy @ It's Almost Naptime said...

I am SO glad to hear that it is all working out. SO glad.

Just sleep some now Lisa. Quit jogging girl. Lie on the couch in your jammies all day tomorrow and watch really bad TV. Okay? Please?

Our God is the God of justice - this is his battle.

Love you -

Gretchen said...

Thanks for the update, sweet friend. Amber told me what a sketch you are--how totally fun. Cannot wait to MIRL someday--to toast your good health. Mad lurve for you. Prayin'.

Bernie said...

Lisa I really hate to see you have to do so many things right now, is their not someone else who can make phones calls and fill out forms instead of you, just being a wife and mother is enough and now you are a patient you just don't need to be a secretary as well. No wonder you are tired and have pain, well not really but I would like to see you get more rest and build your body up for treatment if they say you need it. That is a draining experience as well so you need to be in the best shape you can be. Thankfully some things are coming together, love you sweetie, keeping you and your family in my heart and prayers......:-) Hugs

Sheryl said...

just want you to know that i love you.

TRUTH SHARER said...

Lisa:

I am sorry that on top of all this stress of your diagnosis - that your insurance company has put you through all of THIS too! UGH!

But I do know our God and I know that when He brings us to the edge of the cliff and pushes us off - He gives us the wings to fly or He will be there to swoop down under us and let us ride on the tips of His wings [and that's not a fairtale - that's in scripture.]

TRUST HIM - even through this disappointment because when He closes one door - He opens a new and better one! Praise Him in advance for what He is about to do!

Ultimately - HE is the GREAT PHYSICIAN - and HE [like with me] is your health care provider!

I'm praying often for you...
{{HUGS}} Stephanie

Andrea said...

Lisa,
Thank you so much for this update. I have posted an update to link back here so that all those praying from arise 2 write can come here and read your words of how GOD is indeed in control of this situation. I praise GOD for all HE is doing!

BTW: It is an honor and privilege to pray for you and your family and to rally the troops on your behalf.

Sending great big hugs! Storming the heavens with you, andrea

Charlotte said...

Lisa, Blessings to you and yours as you travel this rocky road.
This Holy Week rest in the Lord and let His resurrection power and presence carry you.

Hugs,
Charlotte

Kelly Combs said...

Thinking of you today. Battling cancer is hard enough. To have to battle the insurance companies too is just WRONG! WRONG! I'm so sorry you havce to go through this.

God's blessings to you & your famiy.

Andrea said...

Goodness Lisa, what a mess! I am so sorry you have to deal with all of this on top of everything else.
You are in my prayers daily. Thank you for keeping us updated so that we can pray specifically.
Blessings
Andrea

Lora said...

Continuing to pray dear one!

He is risen!

Smelling Coffee said...

Still praying for you, Lisa. So sorry that you are battling a physical disease and the insurance company too... but what you said at the end of your post is right.

Praying the Lord's strength for you today... and rest and peace in the midst of it all....

Jennifer

Gigi said...

Good heavens Lisa!!! It is truly a wonder how some people can lay their heads down in peace at night, isn't it?

But as I read your post, one thought kept coming to me...

Man may try and write the sentence, but God places the "period" at the end!! And He is not finished with your story yet!!!

You are ever in my prayers, sister! xo

Donna said...

Thank you Lisa for always letting us know what is going on. That helps us know better how to pray for you and your family. No matter what is going on, you always close your post with an uplifting verse. Know that you continue to be in our thoughts and prayers.

Blessings to you and your family!

Loren said...

Oh Lisa....

Wow ~ that truly was/is a biased panel! That company is something else to say the least. No doubt they will remember this case but I also know that they may always inside their own minds question their actions. I pray for these people .... how do they sleep at night??
I am sooo happy it is all working out for you and the Lord truly is leading your pathway my friend! He will be your Strength and your Shield every step of the way...now rest in HIM! Praying for you my friend!

Lynn said...

Lisa, I am so glad to hear that some doors are being opened! Thank you Lord Jesus!

Blessings,
~Lynn

Shanda said...

Dealing with the medical "stuff" that accompanies illenss and disease can be like a part time job all in and of itself.

Continuing to pray for wisdom, discernment, God to keep brining great connections your way, and REST for you all!

One day at a time...one step at a time. You are loved by many and not alone.

God still has "good plans!"

Ashley said...

I am sorry that the insurance company is doing this to you. I am hoping the new plan treats you better and doesn't make you fight for it.
You are always in my thoughts and prayers.

Saleslady371 said...

Lisa, I continue to pray that all will go smoothly with this new insurance team as we trust God for it along with your total healing.

Love,
Mary

Angel Muly said...

Lisa, I found you through a friends blog (Loren@themagoosnews). I will be diligently praying for you. I cannot imagine what you have been through. I have 5 kids, two of which are identical twin boys with chronic asthma. We have battled insurance agencies for years over that. They are not covered and haven't been for about 8 of their 10 years because it is considered preexisting. This is nothing compared to what you are going through and it wears me out. I will add your prayer ribbon to my blog as soon as I can figure out how : ) I know that God is on your side and you will win this battle!!
Love you
Angel
allthemus.blogspot.com

Cochran Family said...

Oh Lisa, I am SO FRUSTRATED on your behalf. This is just so unfair, really to the point of being criminal. I absolutely hate dealing with anything medical insurance-related. You must be exhausted. I've been following your blog and I pray that things will start going more smoothly for you.

Christiana said...

Sweet Lisa - lifting you (and all the frustrating situations you're experiencing) up to the One who has all the answers. And all the control.

His story of your life is certainly hitting the rough patches, the sticky hard stuff, but there is still much triumph and beauty in store for you.

I really believe that.

Sending you love and hugs from Nashville.

David C Brown said...

"His compassions fail not; they are new every morning", Lamentations 3:22,23

Denise said...

Loving you sis, and never ceasing to pray for you.

Jen said...

God is good. I am so angry at S&W that I could spit nails. (I've always heard that expression but never understood it until now. I could actually spit nails. Only if they were directed at either Scott or White.)
Much love to you, safari sister. I love you bunches!!

~ Being Woven said...

I am praising the LORD for His mighty hand on you, Lisa. He will and is working His will in your life and in the health care for your family. All for His glory. You continue to be in my prayers.
Caring through Christ, ~ linda

~ Being Woven said...

I am praising the LORD for His mighty hand on you, Lisa. He will and is working His will in your life and in the health care for your family. All for His glory. You continue to be in my prayers.
Caring through Christ, ~ linda

Alleluiabelle said...

Precious Friend,

I've been keeping tabs you and continuing to pray for you. Surely this was not the answer that you wanted from your insurance company but as you said, God has opened other doors for insurance. Thank you Lord!

I love you dear friend and know that you always remain in my mind, heart and prayers.

Big Hugs,
Alleluiabelle

mlfont said...

Lisa - you continue to be in my prayers! I say keep jogging, but rest too..the exercise always helps me feel better! Anticipating God's best! Lara

Jennifer said...

God is sooo amazing....I'm glad to read things are coming together. Yes, agree, that this seems to be a lot of work on you part, but apparently this is what is glorifying to HIM.

Marsha said...

I'm so pleased to hear of God opening another door for you concerning insurance. He is kind, gracious and merciful. I'm praising Him for bestowing His lovingkindness upon you.

Blessings.

B His Girl said...

Your care is the most important thing. Shame on them. I pray they are never in your shoes. Let them go. Not worth it. You are : ) B