First shock was the diagnosis: Stage IV Metastatic Cancer. Second shock was the indignities. These did not stem from the proposed or prescribed treatments which were performed with respect and care. No, my insurance company, Cigna, the one I have paid into for decades, objected to pay for diagnostics and treatments my doctors ordered, delaying my diagnosis and care.
I have had a cough for 8 months, and no, I never tested positive for Covid-19. My first diagnostic, during month 6 was an X-Ray, which Cigna questioned, but eventually approved. This showed nothing. In month 7, a doctor finally recommended a CT scan. This was scheduled, denied by Cigna, and then fought over for a week until finally approved and performed. The results threw my care back to a nearby research hospital cancer clinic. I will attest that it is never a good thing when a doctor calls, late in the day, and starts with “I am so sorry to say this….”
As a Stage 2 breast cancer survivor, I had experience with the Clinic and had been followed through the past 7 years after treatment with an annual mammogram. The CT findings were filled with terms for which I had no reference. I began googling the terms, and then the findings from the doctor’s notes. The recommendation was an ultrasound guided biopsy of lymph tissue near my breast. Cigna denied payment for this request but my former radiation oncologist fought for and got it approved for payment. Cigna denied payment for testing the tumor tissue. This still hasn’t been resolved.
Next came a visit with a new oncologist. My new oncologist was carefully blunt: Stage IV. Unknown if it spread to the bone, but the initial CT showed liver involvement. Never good news. To determine how extensive this metastasis has become, she recommended a full PET/CT scan and a liver biopsy to see if the cancer showed the same biomarkers as previously. Cigna objected to paying for the PET scan. My doctor and her staff spent hours fighting for my scan and then the biopsy, performed last week also required her intervention with Cigna.
When I got the oncologist’s notes, I started googling terms, proposed chemo/immuno-therapy drugs and then side effects. On the drug description page were two terms I had not seen before: Overall Survival (OS) and Median Progression-free Survival (PFS). Scary stuff. I resolved to start the retirement process immediately and to quit googling those terms.
Back at the Clinic to start treatment, I was handed a bag of pill bottles as I will be in a clinical trial, an additional prescription, and two prescriptions for side effects. As my cancer has metastasized to the bone, my doctor recommended another treatment that Cigna would not approve. To date, the continued denials for payment have caused hours of intervention from several specialist doctors and their staff, hours in assistance from a senior benefits specialist at my office, and two months of delays in my diagnosis and treatment, with no resolution in sight. As I will start Medicare on retirement, I knew I had more to learn and therefore google, and thought the terms would be safer, less triggering.
Little did I know.
Sfevers
Oh, Susan.
I’m in a training meeting, but I know all this stuff. Happened to pick up my phone and clicked your blog link. Then my heart stopped.
This is criminal.
No, it isn’t criminal. But it should be. And might be if so many members of Congress weren’t in thrall to the insurance companies.
Criminal not in the legal sense, perhaps, but morally.
Ah, Susan. Is there a Rx one of your docs can write you for the side effects of corporate greed and brutalization while coping with everything the cancer itself is bringing? (I have some ideas, but they are neither legal nor moral…)
I’m just so sorry this is the story this far. Let’s talk maybe even visit soon, yes? XO
Very sorry to learn of this diagnosis and the battle for your care and life, Susan. I would say congratulations on retirement and starting Medicare. I just hope the transition to Medicare works to your benefit, at least you can choose another insurer.
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