Revisiting “To Tell or Not to Tell”

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Three generations in Laguna Beach clockwise from left: son Thomas, the shy Author, and grandchild Oskar, all permitted to tell if they think they should

When I was a new blogger, one of the earlier topics I posted on was titled To Tell or Not to Tell wherein I discussed the stigma of cancer and patients’ dilemma whether to tell or not to tell others about their affliction.  I wrote that I had emailed my two sisters – the eldest in Manila, the youngest in Dallas – after a series of tests and imaging that the diagnosis of the tumor in my left lung was cancer stage 4.  Immediately their emails came to a screeching halt, leaving me baffled.

For days, in order to deal with the shock of my diagnosis and my sisters’ abandonment, I scoured the internet and educated myself on cancer. I found Inspire.com and read it voraciously. Finally, I figured out why my sisters simply stopped communicating with me. At first I let them stay quiet.  Consequently I enjoyed the relief because those women talk too much. Okay, in fairness, I admit I do the same. That’s what we do – give each other earaches .

Then one day, I broke it to my siblings gently. I told them I learned from my research that people react differently to news of a loved one having a cancer diagnosis. Some stop communicating because they are uninformed about the dreaded disease.  They simply don’t know what to say to a person with cancer. I had barely hit the Send button when their emails rushed in. They thanked me profusely for breaking the ice. They said they had friends who did not want to be contacted after they received cancer diagnosis.  They figured I’d have the same attitude.  What were they thinking?

I have personally chosen to tell the world through blogging that I have lung cancer, once with cancer, always with cancer, but there’s always hope.  It is my way of giving back – informing and enlightening cancer patients and caregivers – after surviving the 2012 dire prognosis of 8 months to live.

Last year, faced with a second widowhood after 8 years of remarriage, I decided to stay in the retirement resort in Southern Orange County, California where the tragedy happened. I thought, That’s it. What man would be interested in a twice-widowed senior chick with lung cancer stage 4? Forget them! I’ll join the Foodies club, Cannabis Club, Hiking Club, etc. and fill my cup.

Hey, never underestimate the power of a senior string-bikini babe!

The over-55 retirement community’s latest demographic report states there are 6 men for every 10 women in the resort.  I disagree. In the sphere where I move, there are 4 men to 1 woman.  Of course the sphere is super small, as in a corner of the hot whirlpool where we meet every weekday evening to tackle the world’s problems.  As an engineer in my past life, I blended in easily.  One of the men sees me outside the pool at other times and we discuss exciting things like Bring Your Own Everything (BYOE) dances.  I have occasional lunches with another man from another sphere.  A teetotaler and a zero conversationalist, he rants about politics and gives me an earache.  Win some, lose some.

Both seniors asked me, separately, How do you keep busy?  My answer: I blog. About what? they asked.  My answer: About cancer. I am a cancer survivor.  Wouldn’t you know! Their next words surprised me.  Both of them turned out to be stage 4 cancer survivors – prostate for one, skin for the other.  They told only because I told. I told because I had to.

So there we have it.  I still tell.  And telling has consequences, like learning I am not alone, hearing other survival stories, political rants, BYOE dances, etc.

How about you?

 

Insurance Company Denies Payment (Cont)

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Remaining Cool and Unstressed and Saying, “Whatev!” 
I don’t know why nothing is ever easy for me. For a moment after speaking with Dr Brevity’s RN, everything about the appeal of the denial seemed under control. RN had explained to me that appealing denial of payment is one of the things her office does routinely. She said, Just FAX to me the Notice of Payment Denial and I’ll take it from there. Boy, howdy, I’ve got ’em now!

 

The insurance company (IC) has given me 60 days to file my notice to appeal, so after Faxing the Notice of Payment Denial to RN, I marked on my calendar the 30-day half-way deadline and the 60-day drop-dead deadline to make sure I don’t lose my opportunity to appeal.

Awakening in the morning after an evening of July 4th fireworks and a hot dog loaded with topping, I glanced at the calendar to plan for the next  BYOE (Bring Your Own Everything) dance.  What I saw instead alarmed me.  The 30-day half-way deadline lurked only a week away! I thought I better get RN’s status report.

I sent a message to RN through the Patient’s Portal (PP), asking very demurely about the status of our appeal. No sooner after I hit “send,” a notice that there was a new message from the PP yanked my attention.  RN’s responsiveness was awesome!  But my computer, my cellphone, was way too slow because I insist on not buying any more data from the provider.   I could hardly wait for the next day to come for me to go to the computer room to read the message.

The message said: Hi Celia, this is Noreen (changed to protect her privacy), RN.  Dr Brevity’s RN won’t be back for two weeks.  Can you tell me what the denial is about so I can find it?

I was floored!  It’s a good thing I’m cool.  And retired.  And only halfway to the drop-dead deadline.  With nothing else that’s earth shattering to do, I have time in my hands to be mischievous.  I responded to Noreen RN deliberately and methodically, giving her a blow-by-blow account of what transpired between RN and me.  I must have given her information overload!  I haven’t heard from her since.

Left to my own devices, at least until RN returns in two weeks, I went ahead and wrote a letter to IC in strict accordance with their instructions, of my intent to appeal their denial of payment.

Four days after mailing my intent to appeal, I received the SECOND denial of payment.  Obviously Dr Brevity’s staff had already appealed and provided IC all the material needed.  Remember, IC’s reason for the FIRST denial of payment was non-receipt of said material.  Now IC has a new and improved reason for the denial!  The SECOND denial letter said When you enrolled in a Medicare Advantage Plan, you selected a Primary Care Physician to coordinate/authorize your medical care. The services received were not authorized and not payable by Monarch.

I have a good argument, i.e. time frames, etc, with that reason for denial, but IC gave me a new 60-day window to file a SECOND appeal.   Serious stuff!  I decided to go to the swimming pool and upgrade my wading capabilities.  But first, a selfie.

I’d love to hear how you handled your similar situation.

(To be continued)

 

 

 

 

An Appointment With the Gastroenterologist

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The Digestive System – One of the Great Equalizers in the Human Race
Between my Oncologist (Onc) and my Primary Care Physician (PCP), I have had more appointments with specialist doctors than I can remember. It’s probably a good thing because I’ve learned a lot.  Now I can decide which branch of medicine I’d major in when I grow up.  At the same time, going to and from these doctors and writing about them give me something to do, write about, and share with those who give a hoot.

The latest medical specialist who examined me was a gastroenterologist (GE), a doctor specialized in the human digestive system, which includes the esophagus, liver, stomach, gallbladder, pancreas, large intestines, small intestines, appendix, rectum, and anus. It makes me wonder, After dealing with those body parts steadily, does the good doctor eat soul food such as chitlins or the Filipino dish called “dinuguan?”

I am not a hypochondriac preoccupied with my and only my own health issues.  My Onc had sent me to GE after the liver MRI specialist already declared there’s nothing wrong with my liver, in agreement with the CTscan radiologist.  But no!  My Onc had a need to  know why a portion of my common bile duct is distended, even after I told him I’ve had that since the CO-1686 clinical trial three years ago and Dr Brevity never got excited about it.  But Onc insisted, so off to GE I shuffled for my appointment.

What can we do for you today? asked the 20-something intake aide.  I thought you’re going to tell me, I replied with a smile.  She flipped through my record.  It’s hard to find something if one does not know what one’s looking for.  I asked her, Are you the Physician’s Assistant (PA)? The PA, like the Nursing Practitioner, is the closest thing to being a doctor.  Oh no, she said.  With nothing else to do, the intake aide asked me my weight and height, told me the PA will see me in a few minutes and then took off.

The wait for PA was more like 45 minutes.  I suspected she was studying my medical records.  PA, a 35ish Chinese beauty, came in seemingly happy.  She had figured out the purpose of my appointment!  It’s your common bile duct, she said. How long have you had that condition? Three years, I answered. She asked, And you’ve had no symptoms? Like, your urine is not cola colored? Your stool is not pale? To all her questions, I answered “no.”  She instructed me to lie down face up on the examination bed. She poked hard at various points on my tummy to elicit a scream or screams.  No screams occurred because nothing hurt me other than her painted fingernails.  Finally exasperated, she said, I think an invasive procedure to find out what’s wrong with your common bile duct should not be done.  It will do more harm than good.  But I’ll ask GE. He has the final say on this matter.  I’ll phone you as soon as I find out his decision.  Great! I exclaimed. I resisted the urge to do a somersault to celebrate.

Do you drink alcohol? She asked as a parting shot.  I answered, Yes, once a week at a dance in the retirement resort.   It sounded like an innocent confession.  Of course I minimized the fact that the dance event features a live band and BYOE or Bring Your Own Everything, which is wide open to interpretation, as in bring your own everything from the cellar.  Thank goodness the dance is only from 6:00pm to 9:00pm.  With the resort’s bus limo service, I make it to my manor upright every time.

The next day, PA phoned and told me GE said there’s no need to do anything with me.  I said, Yes! and pumped my fist in the air.

Let me know what you think about GE or the weekly BYOE dance.

 

 

 

Insurance Company Denies Payment

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Not a Pretty Picture!

 

My life is filled with conflict.  Fortunately, I dig conflict.  Being a self-proclaimed Drama Queen, I thrive on conflict.  Conflict becomes me.  Okay, you get the drift.

When it became almost clear that rociletinib, the CO-1686 trial drug aka poksceva, had started to differ with me as to its purpose in my well-being, my awesome Onc, Dr Brevity, decided to requisition the services of Guardant.  Guardant is the noted high-tech company that analyzes human blood to determine the types of mutated cells that are coursing through the veins of a cancer patient.  Dr Brevity said he wanted to know what happened to the cancer cell that was once identified as T795, a mutation developed out of my EGFR in exon 19 deletion to resist Tarceva.  Cancer cells do learn to outsmart cancer drugs!

I asked for the results of Guardant’s lab analysis as soon as it became available.  Like the Good Doctor, I wanted to know what new nasties were parading in my system.

I read the report with great interest.  The only problem was, I did not understand a thing about analysis of DNA, genes, and molecular pathology.  Well, what do I know about molecular pathology? I’m a civil engineer; I’m into sewers.  But I got the hang of what the report was saying: Those analysts did not know what to make of the results either because there was not enough material in my blood, consequently, they did not know what treatment to recommend.  So, now, a whole slew of us including Dr Brevity, the analysts, the CO-1686 trial sponsor, its employees and associates, and me, know more than what we did before Guardant came into my existence.  Zip, zero, nada.  And my insurance company put me and only me on notice that they will not pay for the lab’s analytical services.  In other words, you, Ms Senior String-Bikini Babe, shall pay.  The scenario reeks with conflict of interest!  The insurance company’s interest in my funds conflicts with my interest in not paying for anything whenever possible.

Well, I happen to be a veteran of conflicts.  In public events, when the emcee asks veterans in the audience to stand up and be recognized for their patriotic service to the country, I attempt to join those who rise, but a companion always pulls me down and puts me in my place.

I read the letter of the insurance company word for word and found I have 60 days to file an appeal.  I can name a relative, friend, attorney, doctor, or someone else to act as my representative.  The most logical representative is Dr Brevity because he was the reason for the payment denial, which, by the way, was given:  Medical records requested were not received.  In order to determine financial liability or medical necessity medical records are required to assist in a clinical determination. As these records have not been received, this claim is not payable by the insurance company.

It was my turn to put somebody else on notice.  And I did.  Voila!

(to be continued) 

I’d be glad to hear your experience if you have any on insurance payment denial of Guardant’s services.