So, the IVIG I get every four weeks costs, according to the statement from my insurance company I got recently, just over $10,000 a month. As I blogged a couple of weeks ago, I started getting it nearly four years ago, after I nearly died from a very serious infection. I have a feeling that Dr D completely bitched out my insurance company for their previous refusals to pay for it (they basically said I wasn't sick enough to need it) and told them I was thinking of suing. Dr D, like many doctors these days, might actually hate insurance companies more than the patients do.
I received an EOB regarding my September infusion...in early December. It said Big Insurance Company was not paying for it. Huh? I got one of these once before, and it turned out to be nothing, so I forgot about it. Then I got one a week later regarding my October infusion. Three days after that, another one, for the November infusion. Okay, now I'm a little freaked. I called Dr D's office. F, the nurse who also handles all insurance-related things for my case, thought this was rather odd, and she called Big Insurance Company. BIC told her that they couldn't authorize the IVIG, because I hadn't had any recent blood work.
I had bloodwork on August 30th. The September infusion was about ten days after that.
Basically, it boils down to this: they randomply decided they want me to have bloodwork more often from now on. Of course, I only figured this out after calls from me and F to BIC. They never bothered to tell me, or my doctor who oversees the infusions, that they want me to have bloodwork more often, when up until this point, they've only wanted it four times a year!
So, the day before my December infusion, I went for bloodwork. Problem solved, right?
My life should be so easy.
My next infusion is scheduled for tomorrow, which means the IVIG should have been delivered to me today. It comes in an IV bag, in a cooler. As soon as I get it, I have to put it in the fridge. The infusion company, who sends me the supplies and hires the nurse to come and hook me up to the IV and everything, called me this morning. They did not have an authorization from BIC for my infusion this month. I had, and F had, been trying to get a straight answer as to exactly how often BIC wanted me to go for bloodwork- every month? Every other month? No one seemed to know.
I got off the phone with the infusion company, and called BIC. I spent about 45 minutes altogether on the phone with them, about half of that time on hold. They eventually told me they had nothign from Dr D regarding medical neccessity for the IVIG. I sighed, hung up, and called Dr D. When I told F what happened, she burst out, "They're lying!" I told her I had assumed that, since this is an insurance company, after all, and my dealings with insurance companies have NEVER been good, or easy. F and I hung up, with her promising to call BIC right away and smack them around a bit.
A couple of hours later, she called me back. All the paperwork should be in order by the end of today, or tomorrow at the latest, and then the infusion company would call me to set up delivery. Oh, and BIC wants blood from me every month from now on. I texted my nurse to let her know there's an excellent chance we'll have to postpone this month's infusion a few days.
Why is BIC suddenly so gung-ho to get blood from me each month? Well, the bloodwork is to check on levels of various proteins in my blood, most notably, IgG. Essentially, they are hoping the bloodwork will show I am all better, so they won't have to pay $10,000 a month anymore. I should be so lucky, right? After nearly 39 years, a spontaneous cure.
I go through agita like this with my insurance company a few times a year over various things. My son needs occupational therapy, and was getting it (and getting it paid for) for two years, but insurance quite suddenly decided they weren't paying for it anymore. They give me crap about various medications I take to, you know, keep me breathing. They randomly decide that I should get generics when my doctor didn't prescribe the generic. And I have what is considered to be in this country excellent insurance- I work for a public school system in the state of New Jersey, and therefore have state worker health benefits. My insurance is widely considered to be one of the best in the state. I'm sure it is very good if you're someone who's, you know, healthy, and only needs to go to the doctor for a strep throat once or twice a year, and never have to take any medication aside from an occasional Advil for headache. But for people with chronic illnesses, insurance is a nightmare, even if you have "the best".
I don't know all the ins and outs of the health care reform act. However, I do know this: our system is broken, badly, and needs fixing, now. Maybe if we had a health care system like the UK has, and the government paid all health costs, I would not have gone so many years without IVIG, and would not have nearly died not even six months after bearing my son.