insurance frustration

Word of advice: Don't get sick!

Yesterday morning, three days before my quarterly all-day cancer lab appointment, I received a text message from Vanderbilt asking me to call; we needed to discuss the estimate. I knew it was going to be bad news – do they ever want you to call if it’s good? So, I called the number listed and spoke with a representative.

Vandy:
“Mr. Robinson, I see in your account that you have met your deductible and your out-of-pocket expenses for this calendar year.”

Me:
“That’s right.”

Vandy:
“The reason for this call to is to inform you that your insurance provider, UnitedHealthcare, may opt to deny coverage of your CT scan, lab work, and/or oncologist appointment. If they do, you have a right to appeal with your insurance company but not through Vanderbilt.”

Me:
“…lovely.”

They didn’t outright deny me on the phone, but it still really stung. Why? Let’s rewind – back in the summer of 2023 I had a PET scan performed (I wrote about it here) which indicated concern for metastatic spread in one of the two perpetually enlarged lymph notes. The plan was to continue with my normal CT scans as scheduled and then, after a year, have another PET scan performed to see how things were looking.

If you’re unfamiliar with PET scans, they are different from CT scans with contrast. They inject you with a radioactive dye. Then you sit inside a small room alone while you wait for this goop to cycle through your body, and then they perform a CT scan but this time the radioactive gunk will target cancer cells and highlight them more clearly than a CT scan.

So in the summer of 2024 I was set for another PET scan – until UnitedHealthcare decided it wasn’t “necessary” and denied payment. This meant my oncology team and I scrambled to appeal, but it was denied again, meaning I had to either pay thousands of dollars to do the PET scan anyway or opt for yet another inconclusive CT scan. It was ridiculously frustrating.

I told the rep:

Me:
“I know this isn’t your fault, but I have to vent. It’s really frustrating and messed up that a person going into cancer scans has to take a call where someone tells them they could be paying an extreme out-of-pocket expense. I pay for insurance monthly, how does this make sense?”

Vandy:
“I know, baby. I don’t like making these calls.”

I hung up and seethed all day long. I’m frustrated on a personal level, and looking beyond me (I will be okay) I think of the people who are constantly jerked around by insurance company algorithms and forced into three camps: pay exorbitant amounts of money to LIVE, default on their bills and have them go to collections, or go without the treatment they need and hope for the best. This is what the “greatest country on the planet” offers its citizens? A dystopian, capitalistic nightmare where health is dictated by money? Why is healthcare a for-profit business, anyway? Is it even possible to not be jaded when confronted with facts?

Some numbers to chew on. Lots more at the sourced link. Source: ValuePenguin.

I’d be remiss if I didn’t address the biggest news topic of the day – the assassination of the UnitedHealthcare CEO. I’m not an anarchist nor do I pretend to be one. I’m not trying to eat the rich; I’m as altruistic and peaceful as they come. I vehemently disagree with the killer’s methodology and never feel that violence is the answer to solving problems like this. The CEO, good or bad, had a family and a life, and it was snuffed out. I may disagree with business practices but I can’t ever agree with murder.

Having said that, it is impossible to ignore the growing frustration among Americans. Am I a dreamer if I believe that there must be a humane way to deal with healthcare? Unfortunately, the people in charge in our country seem to be content to sit back and do nothing. Is America ready to embrace another way? Because what we’ve got is bullshit. I do my best to try and keep a positive demeanor no matter what is going on in my personal life, making jokes and all of that, but at a certain point there are no more jokes to make.

I’m positive that I will be fine on Thursday regardless of the outcome. I expect a report that tells me everything is normal, to go about my business and enjoy my life, see you again in four months. And if it does go sideways, I will still be okay. But what about the old folks I see sitting in the waiting room desperately hanging onto life? Is their insurance company denying them and causing them stress in an already stressful time?

Alright, thank you for reading my vent session. I appreciate all of you and your support over the last few years. As bleak as it all is, I maintain hope that we will have better options in our lifetime.

I will likely post again after Thursday’s appointment – signing off until then.