I was facebookin' it this morning and an ad for John Grisham's new thriller popped onto my field of view. I couldn't escape it. The title. The Appeal.
The title stopped me dead in my clicks. The Appeal. Now this timing could not be more on target. I am in the midst of one of these with my HMO.
I grappled long and hard (well all of five minutes of key stroke,delete, keystroke delete) with the decision to actually write this down on a blog. I guess when you wear your heart on your blog for some things it's hard to not to do the same for others. Especially, something that I feel so strongly about.
After my radical neck dissection, my neck and face were changed, well radically. After they slice you like a tuna can from ear to ear and remove muscle and tissue, and a hockey team's worth of lymphnodes things do change. The natural outcome, aside from obliterating the mutant invasion of cancer is not so pretty, even three years later. Now that I am in the clear with cancer numero uno and numero dos I decided to do something about it. My doc and prospective plastic surgeon warned me that I would be denied even with his letter and explanation. He was right. Denied. I appealed. They denied. Even with a letter from a state senator, picture documentation and persuasive letters from others on my health dream team. Of course they did. I was prepared for this, but not so soon. Just four days prior to getting my appeal decision I had gotten a HIPPA form to sign. You guys all know that. HIPPA, hippo. WTF. I was getting ready to put this in the outgoing mail when that day's incoming mail brought me my lovely little letter with attached thick packet to take it to the state level if I so choose.
Somewhere in some dusty HMO basement is a big rubber stamp.
Before things had to be all "P.C." they'd spare themselves the trouble of crafting these touchy feely letters to Jane or John Doe and just stamp it on the top of a big blank page.
NOT MEDICALLY NECESSARY
It might as well have said "sucks to be you", "tough luck chump", "invest in a good psychiatrist...but we won't pay for it."
So with that said, you might even be siding with my HMO if you are looking at it from the "business" of things. Yet, let me ask you if you have ever heard of the Women's Health and Cancer Rights Act of 1998. It allows women to receive breast reconstruction if they so choose after a mastectomy and their HMO must pay. Good move. As a friend of several breast cancer survivors there's no doubt in my mind that this should have been passed long ago.
We are approaching the 10th anniversary of this landmark decision. Yet my question remains- is a reconstructive or corrective procedure only limited to one kind of cancer? Do the psychological affects of a radical operation somehow lessen because it wasn't my breast?
As I spoke to my patient advocate on the phone I realized I was not preaching to the choir.
Naturally, I'm not feeling the advocating vibe from a woman whose salary and benefits are paid for by the folks that are denying me. Over the phone the aforementioned HMO "advocate" misidentified several key pieces of information in my appeal. She even incorrectly identified my before picture taken prior to my neck dissection as the after. She had the nerve to say "I fought for you." Sure. I'm not an authorative person...I tend to be tenderhearted, but lately I've felt the lion coming out when I stand up to these HMO paper pushers.
For the Blue Book suggested retail value of a 1988 Yugo I have the chance to have something corrected that was a undeniable result of cancer extraction. DENIED. Go figure. Now I am thinking they may not have heard the last of me.