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“Excuse me, ma’am,” I blurted, abruptly interrupting her professionally designed and polished stream of insane medical insights, “Are you an oncologist?”
“Well, no,” she fumbled, then recovered, “I am a professionally trained and competent consultant for clients of catastrophic illness!”
Oh, that label. I HATE that label. Who worked on that level of alliteration and who thinks a parent wants their child labeled as catastrophic? “Oh good, then,” I continued, my skepticism leaking into my voice, “are you a doctor?”
I already knew the answer; this was the third ‘consultant for catastrophic illness’ I had dealt with in as many weeks.
“Well, no,” she gamely continued, “but I am extremely familiar with cases such as your son’s and his levels of methotrexate are higher than normal. We don’t know if we can approve this level of dosage for his treatment.”
“Are you a nurse?” I pursued my line of questioning as doggedly as she pursued her mantra of not wanting to pay.
“I am not a nurse,” I could tell she was trying to be patient, “but I have been assigned to your case for your protection.”
Ha! My protection? She wanted to withhold medication from my son? She was there for protection all right, but it certainly was NOT mine!
“My protection,” I responded, my blood pressure beginning to rise along with my voice, “and just what is it that you are protecting me from?”
“Well, for example,” this protector and champion of virtue explained, “this level of methotrexate is abnormally high and it’s an extremely expensive drug. We just see that this level may not be needed.”
“Ma’am,” I gritted out between teeth, fighting back tears of frustration, “do you not have the entire treatment protocol sitting in front of you? I had this conversation regarding levels of dexamethasone with the last ‘protecting consultant’ that was assigned to us and I sent her the complete protocol, even though the doctors have already sent it to your company! Andrew’s treatment has already been approved and begun!”
“Well, yes…” she consulted her consulting guide, “but we see that Andrew is on a research arm of a study and we have to look out for logical doses.”
“Oh! “ I gushed, “So you are part of a research team highly trained in medical research!”
“No,” she must have been tired of my questioning, but then, so was I.
“Are you medically educated at ANY level?” I came to the point of my determined queries.
“No, I am just here to assure medical competence.”
“Well, then, let me explain Andrew’s treatment to you!” I launched into medical terminology I had never had any knowledge of previously. “Andrew is indeed in a research study group. You see Andrew has a fighting chance because other children were in study groups and so yes, we signed Andrew up to be part of a study on the levels of methotrexate at his physician’s request. You are right, when we signed up we were terrified that he would be in the experimental group, but our prayer is that our risk will help children in the future to have better statistics for survival than Andrew does. But,” I was a on a roll, now, that I had been waiting to get onto for about 10 phone calls, “we were blessed to be placed randomly on the BASE arm of the study. You know what that means?”
I didn’t really care about her answer, and honestly, I don’t know if she answered or not.
“It means that his treatment is STANDARD PROTOCOL for ANY CHILD under the diagnosis of acute lymphoblastic leukemia and that HIS LEVELS of DEXAMETHOZONE and METHOTREXATE are NORMAL! In spite of the study, his levels are the “standard of care” and, if you are competently trained and here for our benefit, you might write this down in his file so that we do not have to keep having this same conversation every week!”
“Besides,” my indignation kept pouring out, and now tears joined the outpouring, “do you really think any mother would voluntarily and arbitrarily put their child on lethal doses of medicine just to scam your insurance company?!”
I abruptly ceased my ranting, stunned at myself. I was never any good at being assertive, especially on the phone, and I could not believe I had just gotten all that out.
“Now,” my voice was calm and patient again, with only a trace of tears, “do you think you could please stamp an “OK” or a “release” on this particular drug that was needed yesterday so that I can drive the hour back into town and actually be able to pick it up this time and keep my son on his PHYSICIAN DESIGNED PROTOCOL?”
“Hchmm. I believe I can talk to my manager and get that called in for you,” her voice was brisk and business-like again, as if we had been in sync the entire time.
“And, Susan,” I continued, wanting to ride the wave of my assertiveness before it washed back out to sea, “do you think you could look at the next phase of treatment that starts in two weeks and please OK that phase of treatment too, so that I do not have to drive 2 ½ hours out of my way to obtain the drug needed for my son to live?”
“Yes, Mrs. Bovee,” she responded, “I will be happy to OK that right now.”
Oh, I was so thankful that we had connected, that we were now bonded sisters in our fight for leukemia and that together we would see Andrew through this catastrophic illness!
“Mrs. Bovee,” stated my newfound friend, “I see that you are not using a preferred physician or hospital and I wanted to talk with you regarding this. We will not be able to keep paying when you use physicians who are not preferred providers. If you could please check over the list of providers, and seek medical help elsewhere…”
“Ma’am,” I zoomed back to formality, instantly recalling all Randy’s conversations with insurance agents regarding preferred providers (or the lack of them) in our area, “if your insurance company would like to helicopter us from the west coast to the other side of the Mississippi every time Andrew needs chemo, prescriptions, strikes a fever, or develops odd bumps on his skin, I would be more than happy to check out your list of preferred providers that ALL LIVE IN THE EAST!”
“Oh, I see…” answered my extremely competent, professionally trained consultant for catastrophic illnesses.
1. Take names. Be pleasant, but always write down the first and last name of the person to whom you speak and the extension each time you call.
2. Be polite. A simple, “How is your day going?” works better than diving right in with demands and accusations or querulous questions. Remember, insurance agents are people, too, and they are just trying to do their job.
3. Document everything. Each time you call the insurance company, keep a pen and paper handy, or if possible, your computer. The insurance agent is probably keeping a log of your call, so it’s a good idea for you to keep a record as well. Note the date, time the call began and ended and a summary of what the insurance agent said/promised.
4. Communicate clearly. After each question is answered, read back to the insurance agent your summary of what s/he said and ask, “Is this what you are saying?” Adjust your notes to reflect what the insurance agent understands to be what s/he promised.
5. Keep calm. This may be hard when you’re stressed out and put on hold for what seems like hours, or you’ve had the same conversation with the insurance agent about the same issue multiple times. Have something nearby to throw or break AFTER the conversation.
Have YOU ever had any run-ins with insurance agents? How did you handle them?