Wednesday, March 9, 2011

In the Chemo Room: 17 minutes to appeal $176,365 bill

I go back to the chemo room later today, but this morning I sat in on a medical panel that heard my appeal of Anthem Blue Cross Blue Shield's denial of $176,365 of radiation "benefits" I received last summer.

To make that clear: Anthem has initially refused to pay my doctors and my hospital $176,000 for treatments I received through May and June 2010 based on the company's medical protocols that don't consider the type of radiation therapy I received a standard treatment for metastasized colorectal cancer. 

Both my doctors, Thomas Kenney, oncologist, and Seth Reiner, radiation, were on the 17-minute teleconferenced call as the appeal hearing was conducted, and both explained why they prescribed the treatments I was given. The panel seemed to agree, but a majority vote is to decide the issue and I am to be informed in 24 hours how the vote went down.

It was all very professional, and my doctors both said they have participated in such review/appeals in the past. It is part of the "system" of health care we've got going for us here in America, and the new "affordable" health care act passed by Democrats last year probably won't change this part of the system.

The law preserved the role of private-sector health-insurance companies in the health-care industry, so health insurers, in order to preserve profit margins, will challenge doctors on protocols in order to keep from paying as much as possible on insurance policies that are racking up huge costs for care. If the company is successful, the bills fall to the patient, no matter their ability to pay, and the insurance company dodges, in my case, this one $176,000 bullet.

Anthem Blue Cross has already paid much more for my care during my near four-year battle against the disease, so I don't blame them for this attempt to save themselves some money. It's good business.

And its good business on my part and my doctors' parts to appeal initial decisions and make the insurance company pay. That's all part of the initial transaction I made with the insurer, and why I keep paying my ever-increasing premiums. The appeal process adds costs to the "system," but that's a policy the wise heads of industry and government have adopted. 

Of course, a public option to private health insurance might suggest a cure to this national chronic economic illness. But that's another story.

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