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.

In the Chemo Room: Bills

The "Level 2" appeal of a $79,000 bill for radiation treatments I took last summer went into the mail yesterday, and I have before me two more invoices from chem labs for more than $1,000 for services done late in 2010 and as long ago as the summer of 2009 that have not been paid by my insurer.

And that's just the unpaid tip of the huge mountain of dollars that has already been paid by Anthem Blue Cross Blue Shield and myself during my four-year-plus battle against colorectal cancer. 

I'm finally in the process of adding it all up, and hope to write more about it for your reading horror, but also to illustrate the cost of fighting and surviving cancer in Denver which is no small financial hill to climb.

Maybe some of you can share your financial experiences with me if someone in your family has been fighting a serious health issue.

Part of my problem in facing these costs over the years has been my lack of income. I went from a salary just under $80,000 a year to a spotty income of about $30,000 annually for 2007, 2008 and 2009, what with writing a book for pay, doing a few public-relations projects and cashing out my retirement and one life insurance policy.

This past year has been a lot worse, as it has been for many, many people, and I've been borrowing heavily to make ends meet. Strangely, even though I am still taking chemo therapy, I feel as if I have recovered 98 percent of my energy pre-diagnosis, and I'm working hard on writing projects, including this blog, but making no money.

I plan to change that this year. And one of the ways I hope to change it is by writing about how much it costs to survive cancer in Denver, Colorado. The problem with survival, as I've already indicated, is not only that you have to pay for a portion of its expense, but also that you have to pay all the rest of your "cost-of-living," like rent, groceries, car insurance, etc.

So filing an appeal of a medical bill that has been denied by an insurer becomes routine business for a cancer survivor.

And you do it with a kind of a hippie-inspired equanimity because you know your insurer already has spent hundreds of thousands of dollars to keep you alive. You can only be grateful for that, even when you realize you are simply collecting on health-insurance premiums you have paid all your adult life.

Those total premiums, after all, hardly match the cost of long-term cancer care at today's health-industry prices.

But you realize something else as well. What you do not pay for during the four-year struggle is all the support, prayers and love shown to you by friends, family and readers of your blog. You can only be grateful for that, too. So thank you.