Washington, DC–(ENEWSPF)–November 3, 2016
A bunch of people I didn’t vote for, watching out for my interests.
“Ms. Duncan, we’re going to need to see you as soon as possible this morning…..and please bring your husband with you.” My wife’s doctor delivered those words to her at 7:30 am on a Monday, just days after we had received preliminary biopsy results that were all negative. “This can’t be good”, I told my wife as if she didn’t already know.
Half an hour later we were in an examination room when her primary care physician delivered the news in full: “It’s cancer”, he said, “but I’m afraid we don’t know the source yet”. If you are unfortunate enough to get cancer, this is the one of the types you really don’t want to have – cancer of unknown primary, commonly called CUP. The problem with CUP is that it can be very hard to treat, as today’s cancer treatments are precisely matched to the originating source. If you don’t know the original source of the cancer, you most likely won’t have an effective treatment – it’s as simple as that. To make matters worse, my wife’s carcinoma was also “poorly differentiated”, which means it is both aggressive and hard to trace. Like I said – it’s the one you really don’t want to have.
Things could hardly get worse…unless the receptionist walks into the room a few moments later to tell you that there is a problem with your insurance – which she did, and there was. We were certain at that point, however, that there was nothing wrong. We had signed up through the healthcare.gov exchange the previous year and then upgraded our coverage to the silver level to start our second policy. This was big news for us, as we had gone over a decade without coverage due primarily to (non-cancer related) pre-existing conditions that my wife had lived with since childhood.
It seemed impossible that the coverage we were so happy to have could be gone so quickly. Our premiums were automatically deducted from our bank account and (to the best of our knowledge) were 100% up to date – there weren’t any indications of problems when the biopsies were taken just a few days earlier. It had to be a glitch in the billing system – so we thought, as did the receptionist.
Unfortunately, when we got time to investigate we found that our coverage had indeed been cancelled – just in time to find out the very same day as the cancer diagnosis. I’m actually loath to include that detail of the story, as it just seems so implausible, but that is just how it went down. It turns out the payments that we were making never changed when we went from bronze to silver, so we had been very slowly falling behind, although our paper bills never reflected it. In total, we were less than $80 arrears on a policy that was $478 per month (they had been taking $459 for 4 months). We called and offered to pay the $76 but were refused. We now faced the future of a complicated and dangerous cancer with no insurance. We needed help.
Fortunately (it feels so good to use that word!) we found out there are actually some reasons for all those pages in Affordable Care Act. Deep in there somewhere is an appeals process that includes review by an external auditor – meaning that in case your coverage is denied there is an impartial process to ensure that both the insurance company and the patient are acting in good faith. We filed the appeal that same day and got our answer in 10 days: it was the fault of our insurance company that they had been taking the wrong amount out of our bank (they had also failed to warn us of the impending cancellation in a timely manner, among other things). We had to pay the balance due of course, but our policy was reinstated in full.
We’re now approaching four months of testing, imaging, biopsies and chemotherapy. It took nearly a dozen different procedures to even determine what her disease was: a fairly rare type of breast cancer, which has none of the typical hormone markers and (hallelujah!) it appears more aggressive than it actually is. My wife’s oncologist is now very happy with her progress and there is finally a reason to be optimistic.
It’s hard to imagine what this process would have been like before the ACA. All the recent news is about increased costs, but I have to wonder if deceptive billing and cancelled coverage has kept costs artificially low. I’m sure we could lower prices by “repealing and replacing” or “reducing regulations” — but those seem to be just shorthand for “deny coverage to the sick and make sure they can’t ever purchase it again”. What good is cheap insurance if you don’t get to keep it?
Source: http://dailykos.com
