I Love Fall...

Radiation Therapy 101

On Wednesday, I had my first appointment with a radiation oncologist.  The appointment consisted of a review of my breast cancer history, as well as an overview of the upcoming radiation treatments.  I've been reading my "How Not to Die of Breast Cancer" book so nothing came as a big surprise.  About the only thing I didn't know was that I would get my first tattoo ~ a tiny dot that will serve as a reference point for the treatments.  A permanent reminder of my experience, as if I could ever forget.

The radiation oncologist was aware of the situation with my insurance, so they are prepared to hold off on my treatment until November first, when they become part of my insurance network.  And after I got the call from the Mayo Clinic business office, informing me that I would have to pay up front for any out of pocket expenses, I went in prepared to fork over the copay for the consultation, but was told that they don't collect payments at the cancer center.  Anything I owe will be added to my monthly clinic bill.  Huh.  Guess they didn't get the memo from Mayo.  Oh, well!

I know this will sound odd, but I kind of enjoy my appointments in the cancer center.  Don't get me wrong ~ I will be perfectly happy when all this is behind me, but everyone at the cancer center is friendly, informative, and encouraging.  If you have to go through cancer treatment, I hope your local facility is as great as mine.

Reprieve

Dr N just called with the results of my latest batch of tests.  All the news was good.  And the final verdict - no chemo!  Wahoo!  I can't even express how relieved I am.  Mostly I'm just grateful that I don't have to go through all that, that I don't have to be sick and I can go back to work.  I'm also grateful to know, for sure, which direction my treatment will be taking.  I still have to wait a couple weeks to start, but it helps tremendously to know what I'm up against. 

Back in the Ring

Last night I went to bed early.  I haven't been sleeping well ~ trouble falling to sleep, bad dreams, waking up a lot.  So after Walker left for work at midnight, I went to bed.  I know for a lot of people midnight isn't early, but we work nights so for me, bedtime at four or five a.m. is my normal.

I woke this morning still tired, but I had a date with Diva.  She's a pretty great kid, always looking for ways to help out.  I have explained to her in kid terms what breast cancer means, and she's been on the lookout for ways to make my life easier.  With Walker working six or seven days a week, fourteen hours a day, and me on restrictions, things are sliding at home. Diva and I set out to remedy some of that.  I picked her up (I drove!) and we went grocery shopping.  Diva pushed the cart and we finished in good time.

Back home, Diva brought in the bags while I put everything away.  Then we headed to my neglected garden for our harvest.  We dug potatoes and peanuts, collected tomatoes and peppers, pulled some weeds, cut down the dead stuff....we did a good job.  Diva had to be home by noon, for visitation with her daddy.  We made our deadline, though I have to say, I hated having to take that kid home.  Spending time with her is one of the best things in my life. 

I didn't do that much this morning - Diva handled most of the physical labor - but I was exhausted.  To be honest, I think the stress of all this is wearing me down more than the physical part at this point.  Walker called to tell me that he was stuck at work for a couple more hours, so I decided to take a nap.  And boy did I sleep.  I didn't hear Walker come home, though I was sleeping in the living room.  When I finally woke it was after five. And I feel like a whole new person.  I've got my fight back.

I don't know what's going to happen in the next couple weeks, but then, who does?  You might think you have it all figured out but unless you have a crystal ball stashed away, you just can't. So I'm going to do what I have always done: take it one day, even one hour at a time.  Learn as much as I can about each phase of my treatments, whatever they end up being.  Appreciate the good days, spend time with my family and friends, and most of all, trust myself and my decisions.  I've gotten myself this far, and I'll get myself through cancer.

Two Steps Forward, Two Steps Back

Yesterday, I decided to find out exactly what kind of financial headache I was in for with my upcoming radiation treatment.   I have contact information for a very friendly, helpful guy in the financial services area at Mayo Clinic, so I gave him a call.  I explained the situation with my insurance company, and I told him that I need to know as accurately as possible what my charges would be for each phase of the radiation treatment, so I could figure out what the insurance would pay and what my responsibilities would be.  I told him that I want to make sure I can pay my bills in full when they start coming.  I told him about the mess from my first time at Mayo and explained that I wanted to make sure neither of us went through that again.

As usual, this dude was very helpful, but he wasn't able to give me all the numbers right away.  He told me that I need to get a detailed treatment plan, which I should receive at my consultation on Wednesday.  When I have that he will be able to give me an itemized list of the expected charges.  Then he gave me the best news I've had all week: as of November 1, Mayo Clinic will be an in-network provider for my insurance group.  That change will come about a week later that ideal, but I'm willing to wait it out.  It's only a week.  We made an appointment to reconnect by phone on Monday, when we'll call the insurance company together to see if there is anything we can do to bridge that gap in coverage. Things were definitely looking up.

Today, however, I got a call from the business office at Mayo.  They initially called to update my insurance information, but then, they dropped the biggest financial bomb yet in this nightmare: oh by the way, because I took financial assistance on that one previous occasion, I am now required to prepay any and all charges that the insurance isn't likely to cover.  That includes the deductible, copay, non-covered charges, and any amounts above the "reasonable and customary" amounts allowed by my insurance.  Of course, they don't have any idea how much that will be, but I have to provide full payment before I receive each phase of treatment.

What the hell? 

Over the years I've had clinic and hospital bills that I've paid in full right away, and some that  I paid over a period of months.  It's never been a problem.  I've never had delinquent credit cards, never been late on a mortgage payment, never had any sort of credit problem.  I took the financial assistance from Mayo only because they decided, a few months in, that the payment agreement I made (and was current on) wasn't good enough.  They started calling and harassing me for more money, threatened to report me to collections, all kinds of unpleasantness.  Considering that we had a written agreement that I was keeping my end of, I probably could have fought back, but I was overwhelmed by the idea of hiring an attorney, and of course I didn't have the financial resources for that.  When Mayo offered me an out, I took it.  I guess that was a mistake.

Then again, maybe not.  Had I not taken the financial assistance I would still be paying on that bill.  I would probably be in the same boat, or worse, if that were the case. It's possible that I would have turned down the mammogram that detected this cancer, for fear of running up yet another clinic bill. 

I'm not sure where I go from here.  I'm planning share this news with the helpful guy I'm scheduled to call on Monday, to see if he has any ideas.  At my consult on Wednesday, I'm going to tell them that I absolutely can't have any further appointments scheduled before November 1, when in-network benefits will apply.  I'm still waiting to see if I need chemo.  If I don't, prepayment may be a non issue as I'll be able to finish my radiation therapy in 2010.  I've already met my out of pocket maximum for this year, so there should be no additional charges after November 1st.  I did call Dr N to see of the results of the 21 point test are back, but they are not.  Until I get those results, and learn whether or not I'll be taking chemo, I'm stuck in limbo.

When Good Appliances Go Bad

Apparently, the water heater was jealous of all the attention that the shower has been getting.  Last night, I went downstairs to find this:

Yep, looks like somebody's trying to get my attention.   Walker has been tasked with finding a plumber to replace this beast when he gets home from work today.  Just to make sure the other mechanicals stay happy, I scheduled a maintenance check for the furnace, too.  I think I'll just stay in bed tomorrow.

Hanging in There, Sort Of

Today the first bathroom contractor stopped by to give us an estimate for fixing the shower.  A few years ago, we had the same company install the same system into the house we lived in at that time.  The cost was about $2,200, which seemed like a lot of money at the time but they did great work, the bathroom looked beautiful, and they were very professional from start to finish.  I was looking forward to having them fix my shower.

Well, times have changed.  The same system this time around started at over $5,100.  Yikes! There was a discount for this and a discount for that but the total estimate was still over $4,000, well above what I was willing to shell out, the current medical situation not withstanding.  And that price expires at the end of October. So I came up with my own low cost, low tech solution.  I know it won't last long, but at three bucks a roll for duct tape, I can replace it as often as I need to until I get my buns back to work.  Even then I'll take a pass on the five thousand dollar shower system.  That's just out of line. 

As an aside: Walker and I are not married, and the house we live in was purchased by me.  For some reason, when we have contractors in, they want to speak to Walker.  I call for the appointment, I greet them at the door, I sign the contracts, and I pay the bill.  Yet when they're writing estimates and doing the work, they want to deal with Walker.  I understand as well as he does the work that needs to be done, the materials used, et cetera. I'm not just the girly girl waiting for the workers to leave so I can decorate.  Whether they like it or not I butt in when I have questions or concerns.  Frankly, it seems to piss them off.  I don't care.  When I am paying for their services, I am the boss.  The salesman here today didn't push me aside but then, Walker wasn't home.  When they called yesterday to confirm the appointment, the man I spoke with asked twice if I was the sole homeowner.  When I confirmed, twice, that I was, he flat out asked me if I had a husband.  I almost canceled on the spot.  Women may have come a long way, Baby, but someone forgot to tell that to the contractors of America.

Anyway, after the shower guy left, I called my insurance company.  There are no radiation oncologists in my insurance network within at least 75 miles of my home.  To see the radiation oncologist at my regular clinic, I needed to get a "gap extension" to be billed at in-network rates. After many department transfers and much frustration I received the bottom line: my policy does not allow gap extensions, and I will be responsible for any non-covered charges plus ten percent of all fees plus anything priced above what my insurance company deems "reasonable and customary" for each service.  I need a consultation plus a care plan plus thirty treatments.  Even at ten percent, those charges will add up fast.  That is in addition to the out of pocket charges I have already incurred for 2010.  There is no maximum limit for out of network charges.

This whole situation is compounded by the fact that in 2008, I went out of network to Mayo Clinic for treatment of a uterine fibroid.  Mayo offered treatment options not available locally.  At that time I had a different insurance company that did approve my visit to Mayo; however, when the bill came the insurance denied the claim.  After a lot of appeals and other BS, I ended up stuck with about 90% of that bill.  I worked a deal with Mayo where they discounted the charges and I paid it in full, but one of the terms of the deal was that I was not eligible for further financial assistance from Mayo, ever.  I figured, okay, they're not local, I have two options in town,  I won't need to go back there again.  Little did I know.  The radiation oncologist I have been referred to works in my town, but he's employed by Mayo Clinic.  Mayo leases space in my local clinic and runs it as a satellite of their facility in Minnesota. 

 I really want to keep my attitude positive as I continue on this journey but it seems every day gets more difficult.  I could really use some good news about now.