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@SenSanders @ninaturner @fshakir @AriRabinHavt Why health insurance companies are awesome.🙄 A true story. Once upon a time there was a young woman with breast cancer. The first time she was diagnosed, she had three different health insurance companies due to employer made
changes of her now ex-husband. With each change came time spent by the patient and oncologist to update referrals and get approvals. The doctors and medical facilities would not allow treatment to continue without a letter from the new insurer with the second change in less
than twelve months because it would be over a month before the young woman had a medical insurance card. The day before the final chemo, the letter, finally, came. Fast forward two months to time for radiation therapy and the young woman gets a call that unless she pays
$11,000 before the following Monday, she cannot have radiation therapy. A full day was wasted by the young woman making phone calls before getting a hold of someone at the medical billing office of her provider who it turns out was attempting to bill one of the first two
health insurance providers that were no longer her insurance providers. Fast forward to fifteen months after completion of treatment for the first breast cancer diagnosis. This young woman decides to get a small breast lift on the non-cancer breast for symmetry. The law states
that health insurance is required to cover this cost for breast cancer patients. A week after this symmetry lift, the young woman is told by her plastic surgeon that they found a new primary breast cancer in the other breast when pathology reviewed the specimen. So, the young
woman decides to have a double mastectomy due to paternal family history of cancer (breast, colon, ovarian, uterine, lung, cervical, stomach, etc.) at young ages. The young woman is undecided about reconstruction and calls the health insurance company (that has now been her
insurance provider since first diagnosis) to find out about coverage for reconstruction. The health insurance representative when asked, "What do you cover for breast reconstruction?" responded, "Are you asking if we cover breast reconstruction?" The young woman replied,
"No, by law you're required to cover breast reconstruction." The insurance rep the said, "What we have to cover depends on the state where we are incorporated, not where a patient lives. Whether or not we'll cover your reconstruction depends on why you're having a double
mastectomy." The young woman was so pissed, she said, "Well, I don't have anything better to do that Monday." The insurance rep accused the young woman of being rude after giving the above responses in a condescending and annoyed tone of voice. After giving that response when
she could look at the patient file and know about both the first and second cancer diagnosis at that time. Within a month of that second diagnosis, the young woman was told by her oncologist that genetic testing for a #BRCA gene mutation was recommended due to family and
personal cancer history. Blood was drawn and sent for testing. The month was January. The young woman was told to expect results in about six weeks. She had a double mastectomy and sentinel node biopsy. She started receiving bills for the symmetry lift and fought with the
health insurer for a year and they never paid any of it. Who doesn't love fighting health insurance bureaucracy while fighting for their life? The plastic surgeon sent no bill after the first one when the health insurance refused to pay. Kudos to him. Meanwhile,
February, March, April . . . where are the genetic testing results that can inform medical decisions for this young woman? Oh, BCBSofIL tells the young woman they don't pay for genetic testing unless the patient has seen a genetic counselor. Oh wait, catch-22, they don't pay
for a genetic counselor unless personal and/or family history is sufficient to require it. Apparently, the whole ancestral tree must have had or died from cancer? If this young woman didn't qualify based on personal/family history, who did? 🤔 The end of April, the genetic
testing company calls the young woman and advises due to the problems with BCBS paying for the testing, they are offering to complete the testing and only charge patients their remaining deductible. They tell the young woman the insurance says there is $49 and change. The
young woman okays it. Also, amazing that a person has had so many labs, tests, a double mastectomy with sentinel node biopsy and has deductible remaining. Go forward eighteen months from the double mastectomy that January to the next cancer diagnosis. A lump found way up
in an armpit. The medical oncologist decides a PET/CT would be the best way to check the lump and the rest of the young woman's body for cancer. Of course, it is cancer and the woman gets a cancer upgrade (Stage I to Stage IV) on the previous diagnosis from 18 months prior.
The PET/CT is $7,900 and BCBSofIL (yep, same health insurance provider) refuses to pay for it. Why? Their statement of denial states that the patient did not obtain standard of care testing prior to a PET/CT indicating the necessity of this scan. What standard of care test
did the young woman with a third breast cancer diagnosis not get before a PET/CT? According to BCBSofIL, the young woman needed to get a MAMMOGRAM first. Yep, really. A woman with no breasts due to cancer was supposed to get a mammogram for them to pay for a PET/CT. The bill
was never paid by the young woman or insurance. BCBSofIL refused to pay even after the medical oncologist wrote a letter explaining why the young woman could not get a mammogram . . . Even though BCBSofIL had all the records as the insurer through all three diagnoses to know
why the young woman could not get a mammogram. This is just the tip of the awesome health insurance iceberg for the young woman and most Americans. Fighting health insurance while fighting for your life. Go America!!! 🙄 #MedicareForAll is absolutely necessary.
This all occurred in the Twenty-First Century.
This young public high school teacher was diagnosed at 28 and completed active treatment in 2018, but still needs regular PT. She takes one day a week off without pay for it. 1/2
She had to ration anti-nausea meds because insurance limits on amount of Zofran allowed per prescription and how often she could renew. Seriously, the young woman in that fundraiser suffered so many complications and horrible side effects exacerbated by insurance decisions. 2/2
