Friday, March 11, 2011

In the Chemo Room: In it to win it!

I won my appeal! Yvonne Harris, senior grievance and appeals analyst for Anthem Blue Cross and Blue Shield, put a letter in the mail on Wednesday that I didn't pick up until today, informing me:

"After careful consideration of all available information, the Level 2 appeal panel approved payment for the IMRT treatments received in May 2010 and June 2010."

That was a very understated way to tell me I did not owe my doctors and hospital $176,305 that would surely have forced me into personal bankruptcy. So it was a win, win, for all of us, including Harris and her company, and she said as much in her letter.

"I appreciate the opportunity to have assisted in your appeal process," Harris wrote, "and I am happy to confirm this favorable outcome."

It's a story of a health insurer -- a company that is often described as the big, bad wolf of the industry -- coming through for a patient who went through the motions required of him and his doctors to give the insurer its proper grounds for paying a huge claim on the patient's medical-insurance policy.

Harris said that, too: "This decision was based on your clinical circumstances in this particular situation."  That's an important sentence to the company. It provides evidence and documentation that Anthem's decision pertains only to me and no other Anthem-insured patient. It prevents a run on the bank, if you will.

The victory is exhilarating and confidence-building and those emotions alone help in my fight against the disease. The "system" worked like it is suppose to work, and the experience reinforces my commitment to do what my doctors tell me, and maybe live long enough to finish the work I want to accomplish on this earth.

Just yesterday, the Centers for Disease Control and Prevention announced that about one in 20 adult Americans are surviving a cancer diagnosis. Of that 11.7 million in 2007, 65 percent had survived for at least five years, and 40 percent for 10 years or more.

I'm still working on the five, but aiming for 10, now with some confidence my insurer will be with me all the way. 

1 comment:

  1. Congrats on your victory, Bob! And thanks for joining us for the Small Business Chamber of Commerce's Denver IDEA Cafe Friday. If you write anything about it here let me know, I'll put up a link on my Facebook wall and on the Small Business Chamber Facebook Page.