Sunday, January 29, 2012

Adventures in Breast Health - Random Update

I had my interval breast MRI in December, kids, and all is well. I'm all clear and have no appointments until my annual mammogram in July. The MRI itself was as pleasant as those things can be. Fairly quick, painless, and I didn't even notice when they started the contrast material (gadolinium) in the IV this time. I asked the tech about that, and she said it's possible that a different suspension liquid was used in the IV at the radiology facility that did my previous breast MRIs. Seems like a reasonable explanation. At any rate, I was just happy that I didn't get that weird sensation of warmth spreading through my veins. (The first time I had a breast MRI, I thought I had peed my pants when they started the gadolinium drip!)

I gotta tell ya... I really like the breast center I've been going to since I was referred to my breast specialist. They've been remodeling, and aside from the procedures performed there, it's almost like going to the spa. They've made it pretty (though in that medical facility kind of way), comfortable, and the waiting rooms are even stocked with assorted tea bags, water and packages of crackers and such. The morning I was there, as I was lying on the MRI table and the tech was prepping me, she asked if I could see the picture on the wall. (They have the MRI table rigged up with mirrors so you can look at the wall instead of the floor while you're lying there face down.) They had just put it up the afternoon before, so I guess I was the guinea pig that got to approve the positioning. Pretty much dead center in the mirror. Spot on, like the rest of my experiences there. So glad my "girls" are being taken care of in a place that makes an effort to make things as comfortable and pleasant as possible.

In related news, I appealed my insurance company's denial of my annual mammogram as preventive. (For those who may have missed that part of the story, some insurance companies will only cover "screening" mammograms as preventive (they pay 100% with no out-of-pocket or deductibles), and don't consider diagnostic mammograms as screening. In my appeal, I wrote that for many women, a diagnostic mammogram IS their annual screening mammogram. I also pointed out that nowhere in the plan documentation and summary of benefits that I was given, nor in any of the plan info available online, does it say that they make such a distinction. I requested that they reverse their decision and cover my diagnostic mammogram as preventive based on those facts.

And I WON!! They reversed their decision and paid for the mammogram! Score one for the consumer! So ladies... if you require a diagnostic annual mammogram and find that your insurance company denies preventive coverage for it (leaving YOU to pay for it if you haven't met your deductible), file an appeal! Maybe if enough of us do that, insurance companies will abolish that ridiculous policy and stop making a distinction between yearly "screening" and "diagnostic" mammograms.

I am now, however, dealing with a frustrating complication of that reversal of decision. The hospital refused to hold my account during the appeal process with the insurance company, and was threatening to send me to collections for their lousy $412.54, so I went ahead and paid it with my Medical Expense Reimbursement Plan (MERP) card. (The card is for the second half of the $5,000 deductible, which my employer generously covers.) So now that insurance company has also paid for it, the hospital has been paid twice. This wouldn't be a big deal if I didn't have to deal with the third party benefits administrator that manages the portion of deductible covered by my employer.

It STILL shouldn't be an issue, as the breast MRI put me over the deductible anyway, but evidently the third party benefits administrator can't add worth a damn. She's telling me I owe $435.94 to the plan. I asked her how that's possible, since my last EOB states that I have indeed met the deductible, and she has a copy of all the EOBs available to me online. (I know she has them, because I had pull them and e-mail them to her, at her request.) She said, "I might have missed something. Take a couple days, look it over, and then let me know if I've missed anything." SERIOUSLY???  Now I have to do YOUR job?? WTF??? I was about ready to stab someone in the eye.

At any rate, I've been ignoring the whole mess for a few days now. I know I don't owe "the plan" any money, and I haven't received all the bills from the hospital for the MRI yet anyway. Adding to the SNAFU is the fact that insurance company also has one charge from the radiologists listed as out-of-network.... this is the same provider that they've already paid several claims for this year as in-network! After a phone call from me, they are now reprocessing that claim.

Thanks again, funbags, for providing me with so many hours of "entertainment". Then again, I can't really blame the "girls" for the current BS issues I'm dealing with. Those honors go to our fabulous healthcare industry. Or maybe just to the talented employees at the insurance company and the benefits administrator.

Luckily, I'll be going on Mr. Remarkable Monkey's healthcare plan effective February 1st. His new plan has no deductible (just reasonable co-pays), no third party benefits administrator, and no distinction between "screening" and "diagnostic" for annual mammograms. Totally worth the extra $39 it will cost me per month in premiums. At least I think so.

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