Tuesday, April 10, 2012

April 10

Today was one of those days where I feel like I fell into the fire.

As in, you know, out of the frying pan and "into the fire".

The frying pan, in this instance is (has been, rather) my current medical insurance, and the fire would be the new insurance plan.

Here is the back story, for those of you unfamiliar with the saga of my insurance life:

I made a move to a new company in September of 2011. It was a tough decision, in that the company that I had been with prior was incredibly easy to work with in regards to my health struggles. I mean, they were amazing. My direct supervisors? Amazing. HR? Amazing. Our insurance and all-around benefits package? Amazing. ... The company was incredible (I didn't want to say "amazing" one more time) to work for. The only downside was that my job didn't challenge me the way that I wanted to be challenged. It was a little too repetitive for me. I missed the hustle and bustle and unpredictability of my former work life. ... So, when someone I used to work with (or, for, rather) came to me and told me that the bank he was with was growing and they were creating a position in the loan department, and asked if I'd be interested - I couldn't tell him no. Not that it was a snap decision. It was so not a snap decision. My prior company had been so good to me. Their benefits package was, as I have mentioned, outstanding. Even if I didn't always enjoy the job itself, I enjoyed working with the people on my team. All in all, it was a pretty sweet gig. But I longed for the days when I had to multi-task. I missed having a calculator and writing utensils at my disposal, not to mention the option of taking an hour long lunch. ... I missed the corporate world. I missed (gasp) banking. So, I took the job.

Again, let me stress that it was not an easy choice. I had a lot to lose (and I knew it), in the way of benefits. I was a tenured employee and had been with my prior employer long enough to qualify for FMLA, should another health crisis arise. The insurance was mind-blowingly good, not only in how the coinsurance split, but our deductibles were also really low. Again, I was close to a lot of the people I worked with on my team. My brother, Kirk, worked for the company and I was able to see him on an almost daily basis. There were a lot of really good reasons for staying, and yet...

I missed the corporate world. I missed getting dressed up to go to work. I missed my old work life.

So, after some careful investigation of the bank's insurance plan and some serious thought and prayer, I made the decision to make a switch. I knew it was risky, because I'd have to work there for a year before I'd qualify for a medical leave. Also, their insurance plan was a little pricier than what I'd gotten used to... But I figured that the difference in pay would make up for the difference in what I'd lose out-of-pocket towards medical costs. Not to mention my biggest motivator for change - I didn't want the cancer, esp when it was just the fear of it returning, to be what kept me in one place for the rest of my life.

I'd been with the bank for two weeks when open enrollment hit in October and the insurance plan that I thought I'd be signing up for radically changed. The carrier remained the same, so I knew that all my doctors would be covered, but the deductible and co-insurance limits increased dramatically. I took a deep breath, tightened my belt, reminded myself that I'd taken a risk because I hadn't wanted to let fear keep me in one place, and I moved forward, setting hundreds of dollars aside every month for the deductible that I knew I would be hitting with my first battery of tests in January.

Mid-December, we were told that management wasn't thrilled with the new insurance offering that was scheduled to go into effect January 1, and they were looking at other options. The change wouldn't be in place prior to the MRI's I had scheduled for the first week in January, so I went ahead and took care of those, knowing that I would hit my deductible in one fell swoop.

And I did. $1,000 down the hatch, the first week of 2012.

And, as we know, that first round of MRI's showed that there was, in fact, another tumor growing where I'd had two removed. Gulp and double gulp. I'd taken a risk, moving to a new job, hoping that I could go 12 months tumor-free, and I'd lost that gamble. Now I was looking at possibly forking out not only the deductible, but also my $3K maximum out of pocket in the next month or so, should I need surgery. Let alone that I was nowhere close to qualifying for a medical leave, nor would I qualify for STD (that's Short Term Disability insurance, for those of you who may not know insurance lingo - heaven only knows that's not what I thought STD stood for, only a few short - give or take 24 - months ago), as our STD company had a 12 month exclusionary clause.

I was, in the immortal words (uh... word) of one of my illustrious co-workers: screwed.

I was looking at the possibility of having to go out for surgery or cancer treatments, either of which would render me unable to work for a period of weeks or months - when I wouldn't qualify for a medical leave, and even if they granted me one out of the goodness of their hearts, I wouldn't have any STD income for the duration of my absence. Awesome.

Again, as we now know, the tumor hasn't grown. I have not needed to take a medical leave and that piece of the puzzle seems to be holding firm. I'm still hopeful that I won't need surgery until the fall, when I will have reached the 12 month waiting period and will officially qualify for a medical leave.

But back to the insurance drama.

In December, we were told that management was shopping for a different plan, but that for now, anyway, we'd keep what we had. In February, we were told again that they were still shopping. At this point, I had another round of MRI's coming up the first week in March and I asked if they knew when the decision would be made, because my concern was that I'd not only pay my deductible, but also a good third of my maximum out-of-pocket with the current plan, only to have to turn around and pay another deductible and start on a new out-of-pocket with a new insurance company. They weren't sure when the decision would be made, and I needed to have my tests run, so I kept my March appointments, coughed up another $1,000 and proceeded down the highway with my current (soon to be old) insurance plan.

A week ago, I got word that a new insurance company had been approved. Today was the day that the reps from the new company came in and presented it to us.

It has its ups and its downs. (Because, I swear, that's how it always goes.)

The ups:

We're under a larger umbrella, so as of May 1, COBRA is now an option if I were to lose my job. (Previously, COBRA was not an option, as the company I work for has less than 50 employees. What this means to me is that, should I need to go out on a medical leave and for some reason not be able to return to my job at the end of that leave, I now have the peace of mind that comes of knowing that I can continue my health insurance - albeit it at exorbitantly high rates - should I need insurance but be unable to work for a period of time.)

It costs less per month.

The vision insurance is something that I so prefer to what I currently have.

My surgeon is on their preferred provider list.

They will reimburse a deductible that's been paid. (I asked if they'd also reimburse other funds paid toward the maximum out-of-pocket (the few hundreds of dollars I've thrown at office co-pays are just gone out the window) and I got a bit of a runaround. I can submit a request, but was told that it's generally a portion of what's been paid, and it hinges on the similarity of prior and current plan, etc. ... But hey, at least I should be able to get most, if not all, of my deductible credited.)

Just call me Pollyanna.

The downs:

My oncologist is not on their preferred provider list. Neither is my psychologist.

The cancer center itself is not a covered hospital. Banner Gateway is listed, but not MD Anderson. Bizarro. - And not okay, as I need the radiology and imaging and eventually the surgery department in the MD Anderson building at my disposal. (I need this hospital and these doctors approved, as I have a rare tumor and require specific treatment. ... When Dr. W was needing to place me in the hands of a doctor who would know what to do with a recurrent liposarcoma patient, Dr. H was the only one in the greater Phoenix area on his radar. I cannot change providers. I need my insurance company to add my providers to their approved list.)

My copays are going up.

I may not be able to even apply for STD coverage with this new company, as they have a clause that states something along the lines of "if you've received treatment, consulted a doctor or paid any medical bills in the last three months" in their pre-existing exclusionary clause. There may be a work around, and the insurance folks are looking into it, because I haven't actually received treatment ("treatment", for me, is surgery) but chances are that I am now unable to even apply for STD insurance because I have the mother of all pre-existing conditions. (To explain why I may not be able to even apply for this coverage: If you apply for insurance and are denied, it creates a black mark on your insurance record - sort of like having your credit score take a 100 point dump - so it's better not to even apply if there's a chance you'll get denied.) Now, the cancer itself is an obvious pre-existing condition, and I understand why an insurance company wouldn't pay out on that if it was in existence prior to my purchasing a policy, but my concern is that if I can't even apply for STD, then I'm completely out of luck if I get hit by a car or am attacked by killer dolphins or have some other life-altering (and debilitating) event take place. ... Right now, we're just talking about my inability to complete a STD application, but I'm scared out of my mind that this is just the beginning and that I will, forevermore, be uninsurable. Thanks, Cancer, I love you a lot. (Read: I hate your blooming guts.)

*Insert deep sigh here.*

And thus, I am out of the frying pan and into the fire.

Is there a chance that the fire could be squelched? Absolutely. And hope springs eternal that it will be. My boss has asked me to send an email tomorrow morning and copy another manager (whom I absolutely love) with what I need: doctors and facilities I need to have added, etc. They have promised me that they'll do their level best to make this insurance plan something I can work with. I'm hopeful that they can, and that it will all work out; because, right now, the only alternative that I (or they) can see is me trying to find another job with benefits that would cover my doctors. (And this is not what I want to do.)

Good heavens, how dramatic and frustrating this insurance experience has been! I long for the (not so long ago) days when all I cared about was if my primary care physician was listed as a preferred provider, and my biggest medical worry was whether I needed to make an appointment to get a refill on a prescription that had run low, or if my doc would just call it in.


At the end of the day, I have to remember that when I was praying my fool head off in an effort to make a decision about what to do - keep the old job, or go with the new - I had a very distinct impression that everything would be okay. Did the Lord send thunderbolts and make an announcement about which road I should travel? No. But I did have a very distinct impression that I could choose which way I wanted to go, and either way, everything would be okay.

Now, exactly what "everything will be okay" meant is a bit unclear to me (because very little of what's going on in my life fits the word "okay", as I would define it). All I can do is cling to the memory of an answer to a prayer, as I try not to hold my breath for too long, waiting for the answer to this one to come.