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.

 

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Felt a Lump, Blamed Cancer

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Cancer’s only redeeming value is that it comes in handy for blaming anything that goes haywire.  I have blamed cancer for everything from aging to zhingles.  I know, but shingles spelled correctly won’t cover the whole alphabet spectrum.

My most recent addition to the blame-cancer game is a lump on my left arm near the shoulder.  I noticed it one day while soaking in my five-minute vitamin D quota from the toasty Southern California sun while seating on the only patio chair in front of my privacy-walled minimalist manor.  At first I stared admiringly at the lump, delighted that I was getting some muscle definition.  But when I looked at the same area on my right arm and saw nothing there to balance it,  the lump raised my suspicion.  I didn’t think it suddenly appeared but I didn’t know how long the lump has been there.  I had been too busy taking selfies.

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At first sight of the lump, the author celebrated her new muscle definition, or so she thought!

I immediately blamed cancer, returned to my alma mater, Google University (GU) and revisited my mentor, the founder himself, Dr Google.  I asked about “lump in my left arm near the shoulder.” Sure enough, other alumni had already inquired about it.  How dare them debunk the myth that the Senior String-Bikini Babe is an original!

Dr Google had a few things to say about the lump. Its location, appearance and texture based on what I saw and felt, describe LIPOMA, a slow growing usually harmless, painless fatty lump that is most often situated between the skin and the muscle layer and located in the neck, shoulders, arms, and other areas that did not matter anymore after reading the shoulders and arms.  Any one can get Lipoma at any age.  It requires medical diagnosis because the lump may be LIPOSARCOMA, which looks similar but is bad news. I threw some more questions. Dr Google’s answer:  Enough already!  Stop self-diagnosis. See your doctor.

Grudgingly, I contacted my Primary Care Physician (PCP), a gerontologist who makes a living looking for as much wrong as he can find in me. Of course he has his RN for his first line of defense.  I described to her my GU findings.  She said she would ask PCP.  After conferring with him, she connected me with a surgeon, another young handsome Southern Orange County doctor.

Three days later,  I faced the good doctor, Dr Han Sahm.  The name sounds fictitious because it is, to protect his privacy.    Obviously he had already heard from RN everything about the lump.  He jabbed the lump with his forefinger, pushed it around and declared it 99.99999% not cancer. I said, So there is that 0.00001% it is cancer.  He said, I have operated on thousands of this over five years and the results have been 100%.  You have two options: (1) Remove it, or (2) Do nothing but watch it for some time and if it starts to bother you, we’ll remove it.  It will take only minutes.  My decision came swiftly: Let’s wait until it becomes the size of a cantaloupe then do the liposuction.  He laughed, We don’t want to wait that long. We want the procedure to last only minutes.

So there’s my lump story.

Tell me your own lump story, if you have any.

 

 

 

 

 

 

Serious Blogging 101

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Work in progress under the two lemon trees in front of the author’s minimalist manor Seriousness needed here,  too

Ignorance is bliss. Not knowing is a blessing. Those are my crutch, being the new kid exploring the SEO block. Okay, SEO is Search Engine Optimization. I love my new capability to flaunt little blogging knowledge.  I am getting dangerous now.

I noticed on the first day of publication of the post “Ever Wondered How it Feels to Wear String Bikini,” a Victoria’s Secret ad appeared immediately after the article and photo.  I related this to a friend, an SEO genius. He said the Google bots –  short for robots – did that. Bots are developed to sense in a blog what sells, what ever.  Obviously, string bikini suggested sex.  I seriously was not thinking sex ads, especially ones that don’t add cents to the balance of my bank checking account.  Then I notice the ads change daily and they are all suggestive of something, not just sex.  Sometimes no ad appears.  Who knows what the bots have in mind. Or in their metal heads.

Now I know.  A little.

HealthWell Foundation Ran Out of Funds (conclusion)

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Okay, so the Onc’s RN said all I needed to do was drop by their office and sign the document and she’d FAX it right back to Astra Zeneca (AZ), manufacturer of Tagrisso. It sounded so easy. But as it turned out, my “drop by” would be fraught with difficulties, most of them my own doing.  Difficulties are good. They sure make my accomplishment seem more epic.

True to my minimalist lifestyle, I have been without vehicle now for 10 months. I’ve mastered the retirement resort community’s bus system. I took my maiden solo 15-minute trip to Laguna Beach using the Orange County Transportation Authority (OCTA) bus and it worked. I found the way back to my manor on the same day! Buoyed by my initial success, I decided to use OCTA to drop by the Onc’s office, which is in another city. The other option was by taxi. The big difference in the cost of the round trip drop-by: $50 by cab vs $1.50 by 24-hour OCTA bus pass.  I could definitely use the savings to buy me a new string bikini swimsuit.  Priorities, priorities.

I planned the trip.  Actually the OCTA website did the planning complete with maps and instructions.  I packed cut-up apples, cashews, and cheese cubes for snack in case my blood glucose ran low while I was in the middle of nowhere. And of course water. All set with my roommate the backpack carrying the goodies, off we went to the expedition.

It seemed like I was hopelessly lost. I did a lot – and I mean A LOT – of walking to correct my navigation errors.  Finally I made it to the Onc’s office, signed the paper, and headed for the bus to go home. Got lost some more. If I straightened out the path that I had walked, I probably would have reached Canada. But it was so worth the experience and the mission accomplished.  Always in awe of the bright side – that’s me.

The following day, AZ phoned and let me know the application FAXed from my Onc’s office was incomplete. Oh no! Over the phone she and I completed it. The next day, she phoned me again this time for the good news: I am officially in the co-pay assistance program: no need to wait for the IRS document, no need to file my application, no need to call for my refills which AZ – not the specialty pharmacy – will ship directly.  How awesome is that! As I wrote this post, I had exactly 5 Tagrisso pills left. The shipment was supposed to arrive any day.

Saved by the bell!

Please feel free to share your drug co-pay story, if you have any.

 

 

 

 

 

Then HealthWell Foundation Ran Out of Funds for my Tagrisso Co-Pay

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I never thought cancer drug crisis would be knocking on my door. In my five-year journey, everything had been rosy. I received charitable foundation funding for Tarceva straight away, got admitted in a clinical trial on first attempt, and was offered another foundation funding for Tagrisso without any effort on my part. Awesome things just kept falling on my lap.

Then crisis struck. I had just completed my fourth month on Tagrisso and called the pharmacy for the fifth month refill when the boom fell. We have a problem, said the specialty pharmacy employee (SP) over the phone. She continued, The HealthWell Foundation ran out of money to help you with your co-pay.

What? I recently recently donated to the HealthWell fund-raising campaign. Obviously the campaign did not raise enough money.  My pittance of a donation did not  not make a difference.

I asked SP, Will you ship my Tagrisso pills without receiving payment first?  I promise to pay as soon as I decide which bank provides the most conducive robbery escape route.  Of course not, she said.  You need to pay $101.85 in advance to cover your co-pay for the month supply.  The amount shocked me.  I could have used that to pay my smartphone bill.  I got to thinking, How much would it have been if HealthWell totally did not contribute? I asked SP.  She replied, $653.24 for a month’s supply.  My shock increased sixfold! I immediately paid the lower amount just in case the worse has yet to come.  UPS delivered Tagrisso pills to my home two days later.

To give me hope for the immediate future, SP told me she got financial assistance request forms from Astra Zeneca (AZ), the manufacturer of Tagrisso.  She gave the forms directly to my Onc.  He had to fill out a part and I had to do the rest.  To complete my portion, I had to request documents from the IRS to prove that I did not have to file income tax returns for 2016, the year my husband Octo died.  I qualified for filing exemption as a newly-widowed taxpayer.  According to the IRS website, most requests take 10 days processing time.

With exactly 13 pills left (of the 30 pills for which I had sprung $101.85) and a ten-day wait for the IRS response,  the co-pay subsidy situation seemed bleak.  Where would I get $7,800 a year for my co-pay?  I twiddled my thumbs then glanced at the mirror to see how my hair, which I’m letting grow longer, looked.

I kept wishing the IRS would reply faster so I could put its document in the envelop along with my financial assistance application and mail it to AZ before my Tagrisso supply dwindled to zero.

Then suddenly, out of the blue, my Onc Dr Smiley’s RN phoned and told me Dr Smiley received authorization to prescribe Tagrisso for me.  AZ will fill it for free! She added, All you need to do is drop by and sign a document.  I will fax it back to AZ immediately.

What?!!  Is another awesome thing fixing to fall on my lap?

I will keep you posted of the developments.  I have a very few Tagrisso pills left.

Do you have a similar situation? Let’s talk about it.

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The Author,  Celia Ruiz Tomlinson, just figured out how to do a caption. Hah!

 

 

 

 

 

 

Success in Posting Photo….Almost!

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First, I’d like to thank those who offered to help me with the posting of photos in the pages of my blog. I really appreciate the responses that I got through the post, email, and Facebook.

So based on my understanding of the process, I posted the first blog update that would contain a photo: Ever Wondered How it Feels to Wear String Bikini?  As soon as I opened the published post, color drained from my face.  It was embarrassing!  I saw a paragraph giving a warning about what might be an offensive photo at the end of the story and the photo itself near the warning!  It happens when a former hot shot is determined to tackle modern technology.

Anyway, being the self-proclaimed “la gran senora” of positive thinking, I declare that it can only get better from that post forward.

Tell me what you think.  I can handle it.

 

 

 

My Fifth Cancerversary

I never dreamt of writing a post about my Fifth Cancerversary. Never dreamt of writing about anything – period – five years after my 2012 Stage 4 lung cancer diagnosis in which an oncologist gave me 8 months to live without treatment, 11 months to a year with treatment.  So on the first minute of the first day of this June, my cancerversary month, I fantasized about backhanding that onc across the jaw if he were still alive. He absolutely had no business telling me or anyone with cancer about expiration date. Fortunately, wholesome productive thoughts stopped my fantasy of vindictivess dead on its tracks.

Most people reckon their cancerversary dates from the date of diagnosis.  Not me.  I am  non-conformist extraordinaire.  I had established my cancerversary month – notice month not day – based on the month my cancer journey began.  It was June 2012.  I remember it very vividly.  I had a cough that did not seem to quit.  I blamed LA’s smog, the airborne dust caused by landscape men constantly turning the soil in the retirement resort, the red grease floating in the bowl of Mexican menudo.  As fate would have it, in late May of 2012, a judge in Albuquerque summoned me to show up for jury duty, or else.  I had no choice but to tuck my tail and comply with the judge’s order.  Something about the “Or Else” stuff from a judge that sends me on flight mode every time.

First thing this June 1st, ideas whirred in my head.  What does Fifth Cancerversary  mean to me?  It means beating the odds and the thunderous call for celebration! Being a self-proclaimed hedonist (“Hedonista”), I immediately considered throwing a bacchanalian party to celebrate life. I’d rent a place, invite family, friends, fans and followers and we’d all gorge ourselves on oysters on the half shell, crab legs, prime rib, rack of lamb, potatoes, pastas and salads of all sorts.  And of course desserts.  I’d hire a DJ to play music, rock the place, and work off the gluttons’ calories.

But my Inner Altruist (“Altruista”) intervened.  A heated discussion transpired between Altruista and Hedonista.  Haven’t you heard of “a cause greater than yourself?” asked Altruista, contempt dripping from her voice.  Hedonista raised her eyebrows and broke into laughter. Greater than me?  There’s no such thing!

Altruista persevered.  She changed her demeanor from contemptuous to sympathetic.  She knew she was dealing with a drama queen.  Altruista explained to Hedonista that second chances go to people who pay forward and help others.  Hedonista interjected, I thought I was already doing that with my blog! One famous blogger told me that my blog is my purpose.  Altruista went farther to penetrate Hedonista’s dense head.  Finally Hedonista saw the light.  Her eyes widened.  Got it! she exclaimed: You want me to pursue a life of “blogging plus.”  Altruista clapped her hands and did a happy dance. I’d been transformed!

That transformation made me feel good, so good that I felt like bursting into a karaoke.  I even thought of paying my income tax early.  Then it dawned on me: I need  specifics.  I asked Altruista, What would consist “blogging plus?”   She answered, First, yank yourself out of retirement and go back to employment. The word “employment” threw me a mental block so hard that my train of do-good thoughts came to a screeching halt.

I moseyed on back to my last blog post, the one covering the CT Scan Report, the one to which many followers can relate.  I re-read their comments on the post on Inspire.com and the social media.  One faithful reader, also a cancer survivor, even sent me a private email and her message stood out.  She wrote, “…….I was so discouraged Friday evening and then I started reading your blog posts and the cloud went away.  You are an absolute delight and a tonic to all of us in this cancer journey. I can’t tell you how much I appreciated your bright outlook and good humor….” 

Whoa! Had I remembered that someone would reassure me in writing that I am already doing an awesome job of serving my purpose, I would have not involved two of my multiple personalities in figuring out the contents for my Fifth Cancerversary in my blog update.

In conclusion, on this my Fifth Cancerversary,  I thank every cancer patient, survivor, caregiver, their relatives and friends who read my blog and validate my service in words or in thought.

 

     

 

  

The CT Scan Report

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Is this for real? Please, somebody, pinch me!

Hah! I get to use that opening after all.

May 5, 2017 CT Scan Day 11:30 a.m.

Being with the One-Man-Band Onc also known as Team Smiley, I did not know exactly what to expect.  But with all my CT Scan experience at 4 university hospitals, I figured, there would be the 4-hour fast before the CT Scan procedure, which normally takes 5 to 8 minutes.  I had been told to report at the hospital at 9:30 a.m. for processing.  I surmised if the CT Scan started at 11:30 a.m. I should be out of the hospital by 11:45 a.m.

Surprise!  Right after completing the insurance paperwork at 10:45 a.m., a twentysomething female nurse assistant escorted me to the Radiology department.  A male technician, 30’s, in hospital blues, led me to a tiny room separated from the rest of the world by a colorful curtain and handed me two bottles of barium berry-flavored drink. He said, Start drinking the first bottle at 11:00 a.m. Drink it over a 30-minute period, which means ending the drinking at 11:30.  Take a 30-minute break, then start the second bottle. Drink it slowly for 30 minutes, or until 12:00 noon.

I did everything according to the instructions.  After drinking all the berry-flavored yuck, I went outside the curtain to turn over the empty bottles and hopefully get started with the CT Scan. There was not one soul in the room.  I had been abandoned!  With the two empty bottles in my hands, I paced the floor frantically, like a wino needing her fix badly. Finally, a tall Anglo man, wearing a hospital mask, entered the room.  He asked, Can I help you?  I answered, What do I do with these empty bottles? I’m done and ready for the CT Scan.  He said, Put them in the trash can.  I asked how about the scan? He replied, Someone will get you.  Sure enough at 12:30 p.m., the technician in hospital blues reappeared.  He led me to the CT scan room and worked the CT Scan machine.

CT Scan is CT Scan in any hospital.  I have already memorized the instructions: Take a normal breath, hold……….Carry on with your breathing.  I am always happy to hear that I have the permission to breathe again.

May 8, 2017  Result Day 

Dr Smiley’s Registered Nurse left a message on my smartphone, giving the result of the CT Scan, and telling me to call her if I had any questions.  I returned her call. At first, she could not remember who I was because she had made many calls to various patients.  I asked her questions to which her answers were, I don’t know.  Finally I asked her, Is the information in the Patient’s Portal? Her answer: I don’t know.

The information is in fact in the Patient’s Portal. Here it goes:

The latest CT Scan images were compared to those of  January 2017, done at UCI.

Lungs: Overall improved relative to the January 2017 images. The main pulmonary nodule, the “flying saucer” at the lower left lobe, was 4 mm x 9 mm, reduced from 7 mm x 25 mm.  No new or enlarging nodules.

Tagrisso came through for the Tagrisso Tiger! That’s the new title given to me by a fan.

Innards:  Mild intrahepatic biliary dilation with prominent common bile duct dilation Stable. No evidence of metastatic lesions.  Liver function tests are slightly elevated. Normal bilirubin.

I remember having that intrahepatic biliary dilation when I was in the CO-1686 trial. It resolved. Here it is  https://celpeggy.wordpress.com/2015/02/02/my-co-1686-ctscan-report-says-nothing-grew-something-new/  If the link does not work, it’s in the February 2015 post in the archive.

Dr Smiley wrote that he will request the insurance company to get an MRI of the liver anyway, regardless of the radiologist’s statement of No evidence of metastatic lesions.  Isn’t he sweet!

There was no mention of the occupier of the adrenal.  It must have resolved.

That’s it.  No After-CT-Scan consultation with Dr Smiley.  It’s kind of different from what I’m used to.

Go Tagrisso!