Friday, September 14, 2012

TGIF and Insurance Issues

I am so glad it's Friday!  Tired this week.  I think I've been staying up too late reading.  Also, my horse trainer is at a show so I've been going out to the barn most nights--which is OK because I want to spend more time riding anyway...

I received a call from Cara, Dr. Balnap's physician assistant (see earlier post about liver surgeon)  she said my insurance said that they consider him as "exclusive" but I think she meant to say "excluded"....  They will only pay him as an assistant surgeon at 20% and he wouldn't be an assistant surgeon!  So no 60% for out-of-network coverage.  I didn't know an insurance company could "black-ball" a surgeon...  I'm not surprised since Select Med is part of IMC and that is where he started the liver transplant program.  I'm still going to see him on Wednesday.  I just want to know what he thinks..  It did make me angry for a minute and then I got all frustrated with this stupid CANCER!  Why does everything have to be so difficult?  Why can't there be a "standard" treatment protocol?  OK. Enough of the negative!  I feel better now.

Here's my plan... go see Bruce B. on Monday (oncologists P.A.).  Talk to him about my options.  See what he thinks about Belnap and ask him about seeing a "specialist". I may even talk to their Patient Advocate to see if they can help me with getting the insurance to approve a specialist.  I'm thinking Dr. Liu at Vanderbilt University in Nashville.  They have this scan called a Gallium 68 PET that is not offered everywhere as I think it's still experimental.  It shows much clearer images of tumors, etc.  Better than the octreoscan.

Go see Dr. Belnap on Wednesday--get his opinion.

Then I'll probably just be waiting until next month to get my blood work done and follow-up scan in November.  If scan shows any progression of tumor growth or new tumors, go see a specialist ASAP. If everything is stable.... wait and worry!

Hope everyone is well and have a great weekend!

Wednesday, September 12, 2012

Insurance

I just check my insurance and I do have out-of-network coverage.  $1,500 deductible and then they pay 60%.  Not great but at least it's something... if I decide to have surgery.  I can also appeal if they will not cover it, if I can prove it's necessary.  Many options...

Liver Surgery Possible?

Sorry it has been so long since my last post.  There a two reasons. One, I haven't had anything to update. That is why this cancer is called "wait and watch" but I call the "wait and worry".  The 2nd reason is I couldn't figure out how to!  I was signed in under the wrong email address and it wouldn't let me create a new post!  Hahaha.  I'm not very technical. I did figure it out--obviously.

I do have something to update.  I went on a trail ride with my friend Ellyne.  She works at the hospital where I had my surgery.  I was giving her the "update" and I told her how they said there wasn't a surgeon in Utah who would remove my liver tumors.  She said she thought she new of one who had actually started the liver transplant program at Intermountain Medical Center but that they had gotten rid of him because he was a "cowboy".  By that, I think she meant that he was a bit of a wild card and perhaps unorthodox.  She told me his name so I planned on looking him up to see where he was practicing now.  I procrastinated on that and hadn't looked into him yet when I ran into another acquaintance who happens to be an anesthesiologist.  I'd wanted to talk to her since my diagnosis but hadn't run into her. She has a horse at the stable where I keep my Abbie.  Anyway, I saw her so I told her what I'd been through.  She told me that she worked with a surgeon who did liver surgery all the time!  It was his specialty.  Guess who it is?  The same surgeon.  Dr. Legrand Belnap is his name.  She asked me for my cell so I gave it to her.  She was going to talk to him for me but said he was on vacation this week.

I went home to look him up and of course, he works out of another hospital that is not on my insurance plan.  Sigh... I figured he wouldn't be since NO ONE had mentioned him to me!

I received a text from Julie, the anesthesiologist, yesterday and she said his PA was going to call me.  Wow.  it was only about an hour later when I got the call.  Very nice lady named Cara.  She said he did debulking and resection surgery on Carcinoid patients all the time!  He gets referrals from surrounding states and even from my oncologist!  I told her he (Dr. Belnap) wasn't on my insurance.  She said they could try and get it approved but that my insurance company probably wouldn't OK it.  I ask her to try to get them to for a 2nd opinion-type appointment.  She set me an appointment up for next Wednesday at 7pm!  Late clinic hours and he wants to see me last so we have plenty of time.  I have to go pick up my CD of the CT Scan I had done in June today so he can see it.  I'm a little nervous about it but I just want to see what he says. I know the insurance won't approve it but I have a couple of options.  I can appeal their decision with letters from doctors stating the facts--that removing 70% to 90% of the tumors can increase life expectancy by 10 years!  I can also wait until June and change my insurance plan for the new plan year starting July 1, 2013.  I could then have surgery.

I'm not really sure what I should do.  Should I have surgery when I'm feeling good, have no symptoms, liver function is normal?  Should I wait until things progress (if they haven't already)?  I will be asking many questions of Dr. Belnap I am sure.  I also have an appointment this Monday with my Oncologists PA, Bruce.  He is very smart and I have a bunch of questions for him!

I will give you an update after my appointment on Monday.