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: Financing alternative care

"It is quite emotional when you're fighting for your life and you are out of money."

Those are the words of Sue Memhard, recent founder of The Emerald Heart Cancer Foundation, a new Colorado nonprofit that is raising money to help women fight cancer through alternative and complementary methods.

My last two reports from the chemo room opened a discussion between readers about the high cost of conventional cancer treatments and the lack of financial resources (meaning health-insurance coverage) available to cancer patients who choose alternative care.

"The foundation was started last year," Memhard explained, "as a result of my own personal experience of trying to find financial help for myself while I was doing alternative treatments for breast cancer. I'm a three-time survivor and I found that there were no organizations that could offer financial help unless an individual was doing chemo.

"I had developed very significant chemical sensitivities from prior chemo that I had taken a number of years ago," she continued, "... [but] everything that is not under the umbrella of the conventional care system is pretty much not covered by insurance. So even if you have insurance, it really doesn't matter.

"It's all out of pocket, and it's quite expensive."

So Memhard and her husband moved to Colorado from Massachusetts to get her under the care of a local alternative-care practitioner, putting the family under significant financial stress. When her husband, who is still looking for a job, asked what Memhard wanted to do here to help the couple survive financially, she said she wanted to start the nonprofit, no small expense itself. Part of the money she is trying to raise will go toward her own salary (which effectively means her medical bills).

And that's how creative you have to get when battling cancer from a pocketbook. My last post described some of my own bills; besides Memhard, the blog inspired Dr. Robert Zieve of Prescott, Az., to contact me about a conference in Phoenix next month that will gather experts on alternative and complementary treatments that are far less expensive than conventional chemo and radiation.

But that doesn't mean alternative treatments don't also cost patients their accumulated fortunes. Memhard called the three $500 grants her foundation has already awarded three women from Connecticut, New Jersey and California "a drop in the bucket" toward the total cost of their care.

That's also why she is actively looking for donors and other sources of financing to get her foundation up and running at a scale that might approach the great need traditional health insurers continue to ignore.

One of the things I've found that is a little debilitating about fighting cancer as hard as you might wish to fight it is the realization of your own uncertain future. Conventional cancer doctors estimate your survival times at various lengths: usually from three to five years. If you are found cancer free after five years of being cancer free, the docs will tell you it looks like you're cured, but not to count on the disease not coming back.

So the shadow cast by survival remains hauntingly over your shoulder, a little dark cloud no matter how well you might be feeling.

"It's quite emotional when you are fighting for your life and you are out of money," Sue Memhard told me.

A professional counselor with 30 years experience, Memhard also uses the foundation as a conduit for providing free telephone counseling to women who are facing the emotional anchors that threaten to pull you under while you are fighting the disease. She could use a little help along her way.

Give her a call at 303-993-8843 or go to her website at http://www.emeraldheart.org/. Whether you need help or can offer some, she'll welcome your call.

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.

In the chemo room, III

I'm actually out of the chemo room as I write, but my coming out is one reason for a new chapter in this series.

A week ago, I had my last of 12 treatments in my second round of major chemotherapy, and I will soon be scheduled for another PET scan, an imaging procedure that involves injecting me with radioactive dye that lights up the areas of my organs where cancer cells are being produced at an abnormal rate.

In other words, the scan will show my oncologist, Dr. Thomas Kenney, what effect this second round of therapy has had on my cancer. Kenney and I will then discuss what further treatment I require to keep myself alive.

Kenney is now treating me as if my colorectal cancer is a chronic disease, not curable but treatable, probably a little like Elizabeth Edwards, whose breast cancer has been described the same way.

One PET scan has already shown that cancer producing cells in lymph nodes in my chest and in my lungs were being kept in check during the first three months of this round of treatments. Kenney, however, doesn't really know what to credit that development to. No oncologist can.

My doctor prescribed a combination of Irinotecan, a cancer-killing chemical, and Erbitux, a cell-starving biologic, for this round of treatment; but cancer doctors treat you according to their knowledge of the latest results of clinical testing of all the drugs available to them for specific cancer treatments, and the result is largely as individual and random as a toss of the die at a Central City roulette game.

The only thing predictable about the treatments are their side effects, and since my experience of the side effects of my two infusions followed past patterns for the drugs, the doctor and nurses who treat me guess the treatments are doing what they are supposed to do: reduce the spread and rate of reproduction of cancer cells in my body.

The new PET scan will confirm or deny that assumption.

Other than a sick day or two on the day of the treatment and the day after, I have been feeling pretty good most of the time. I haven't felt some bothersome pains in my chest, especially after hard labor like hauling downed tree limbs around my backyard, since the treatments began; but then I haven't had many tree limbs to haul since then either.

I feel like the treatments are doing some good, but the new PET scan will confirm or deny my self diagnosis.

So I asked my doctor about alternative treatments.

Clinical trials, for instance, if any are being conducted locally, that might lead to a cure of the cancer rather than mere abeyance; or perhaps nutritional therapy, which you frequently hear about saving lives.

"Most doctors won't take on this discussion," says one line in a book I'm reading called "Ultraprevention," by Drs. Mark Hyman and Mark Liponis, proponents of alternative treatments for a variety of ills.

And the authors were right about Kenney. He said he would leave any research of such "cures" up to me because he, himself, has seen no "data" -- and I know he updates himself on the latest data on everything as quickly as it is released -- that suggest proven beneficial effects.

Kenney plays percentages like the general manager of a professional baseball team, and he allows for only scientifically derived percentages of tested treatments to direct his care for patients.

That's more than okay with me, actually, since he made it clear to me at the beginning of my treatment that the cancer-fighting game is largely one of percentages. I figure Kenney's professional transparency is a lot more than you get from a banker nowadays.

So I'm reading this book called "Ultraprevention, The 6-Week Plan That Will Make You Healthy for Life." I have already watched a CD about dietary treatment of cancer, but the CD ranted on and on about why the "cancer industry" was all wrong in the way it treats cancer patients, while it offered little on the diet it suggested might cure you.

Both the book and CD were sent to me a while back by two friends in Chicago, but I largely ignored the advice until it became clear to me that Kenney was probably going to having me on Erbitux for the rest of my days.

The biologic, which attacks a sort of anchor that is characteristic to certain colorectal cancer cells, costs as much as $4,500 per month per treatment according to some of the latest news about it, and my health insurance company, Anthem Blue Cross Blue Shield of Colorado, so far has sported for the full costs of my chemotherapy minus copays.

I do pay $1,100 monthly premiums for the coverage, however.

I'll write another chapter of this series when I get the results of the PET scan to let you know how I'm doing. I'm also going to back track through my treatments to give you an idea of what it costs to treat colorectal cancer in Colorado, an idea originally conceived as: "What it costs to BEAT colorectal cancer in Colorado."

Developments have augured badly for a cure since that original thought occurred, and the energy robbed from you from cancer treatments also interfered with producing such a series of posts on an appropriately efficient schedule.

I do mean to finish the project. Stay tuned.