Hits Still Coming

It’d be ok with me if I could get off this ride.  You’d think by now it’d mostly be over, right?  No, I’m reminded daily how much more travel down this path I’ve got to still go.  The closet, or as I call, The Tomb of Lost Shoes and Purses, is a place I rarely go.  And, as anyone who has been to my house recently can attest, I’ve successfully transferred my clothes to the living room, shoes and all, obviating the need to visit The Tomb for anything other than a brief consult with the ironing board.  I haven’t even begun to think about starting to wonder what the heck I’m going to do with all the other stuff, like her mementoes and books and collection of fingernail polishes and makeup and year books and music CDs and wedding dress and Halloween costumes and girly things and…. The list just goes on and on.  Of course, that’s just one big piece of the party.  I get other pieces in the mail daily.

Last Wednesday I got yet another letter from Humana, the insurance company that we’ve had since this started.  I get a LOT of letters from Humana, most of which are pretty thin and stay unopened, mostly out of denial or maybe just purely out of apathy.  However, the weight of this visually undifferentiated envelope grabbed my attention.  The contents of the envelope held it.

Stuffed in the same type of envelope as all the other noise Humana sends me were six pages of terse verbiage explaining that Humana has decided to deny all insurance claims associated with one of Maggie’s clinical trials because they don’t believe participation in the trial was medically necessary.  Nifty.  Not medically necessary.  I have so many issues with that perspective that it’s hard to separate them logically.  But, the issue screaming the loudest in my head is – how could a clinical trial ever be deemed “medically necessary”?  A clinical trial is, by definition, a “let’s give it a whirl and see what happens” type of thing, ESPECIALLY a Phase I trial.

Of course, in good Humana/Big Company Insurance form, they further complicated any attempts I might make to better understand and, thus, fight this decision with trickery.  First off, they referred me to the official place where they keep the rules, what they called the “national recognized criteria” (and I’m quoting exactly):

 www. Humana.com/Medical Coverage Policy/Clinical Trial

Now, a quick glance at that line and you’d assume it was a web link, right, with the “humana.com” bit and all?  Well, it’s not.  Web links don’t include spaces, ever.*  So, maybe it’s a navigational hint at where to go on their web site.  Ok, after about three or four minutes of scanning the main page of their web site for “Medical Coverage Policy” I concluded that, nope, it’s not a navigational hint either.  So, thank you, Humana, for telling me that our claim was denied in accordance with the “national recognized criteria” that can’t be accessed.

*  Technically, they can include spaces if the spaces go through a process that’s called encoding, that is, converting each space to the special character string that computers understand as spaces.  While I can’t for a minute imagine that the person who typed up this denial letter knows this tidbit or, even more asinine, could have expected those who received this letter to know this, just in case, I tried that little trick, too, and got nada.

After reading thoroughly the claim denial letter, which was written by someone with a pretty good grasp of the English language but missed the class where the professor talked about communication, I found I do have the right for an appeal.  I just send Humana (the same folks who denied the claim) my reasons why I think they should pay the claim.  Ha!  They promise they’ll get back to me.

Now you’d think that several years spent buried in insurance and medical jargon hell would prepare me for deciphering the goobledy gook they spew and, well, it has.  But this crap takes it to a whole new level.  I have no clue as to what most of the crap in this letter means and/or/if/ how they apply to our/my situation.  Nifty.

For my next trick I get to man up and get on the phone with Humana to discuss what to do about these claims.  I haven’t done this yet because I’m dreading the conversations I’ll have but I have to soon.  I think I recall somewhere in the document that I have a mere 15 days to disagree with them.  Geesh.  I have 15 days to get back to them.  They took 5 months to get back to me.

I suspect that because they denied this claim, the other clinical trials will be denied as well, each of which I’ll likely have to fight individually.  They, of course, probably are counting on my passivity so they can avoid paying more claims for her.  I won’t kid, it’s hard to fight these little battles when I feel like I’ve already lost the war and with heavy casualty.  But I have to fight.  Back when I had the energy to pay closer attention (say, October of last year) I seem to recall calculating that each visit to MD Anderson for the clinical trials totaled somewhere between $20,000 and $60,000.  Each visit.  And we had quite a few.  Must… fight… insurance… shanaygans….  Very tired of fighting.

The five month anniversary of my sweetie’s death snuck by me unnoticed.  Sunday, I flew to Vegas for a quick trip with a friend and was apparently much more focused on that.  Vegas was tough, though.  So, so, so many memories of us there playing haunted me seemingly everywhere.  I stayed at the Belagio.  She and I stayed there for our post-Vegas wedding vacation.  We spent a lot of time in the amazing flower garden and oogled the flower/mushroom/whatever entrance there, too.  We ate there, walked here, blah, blah, blah.  At any given minute my fingers were itching to tap out the number of her cell phone so I could call her.  It was tough.  Again, when do I get off this ride?

All this aside, I’m doing ok still.  I’ve been happy.  I’ve been sad.  It’s very, very difficult for me to get wrap my head around how long its been since the last time I kissed my sweetie.  We’re working on nearly half a year now.  Wow.  Just hard, hard to believe that so much time has passed.  Wow.  I feel like in some ways I’ve failed miserably to adjust and be “ok” and in some ways I’ve blown the doors off.  I guess I’ll get up tomorrow and keep trying.

8 thoughts on “Hits Still Coming

  1. Chris,

    I’m Henry’s girlfriend – I’ve followed your journey from the beginning and only had the pleasure of meeting Maggie on three occasions. I’ve never commented before because I felt like it wasn’t my place – I can’t even begin to understand what you, your family and friends have been through.
    Despite this… regarding the insurance garbage – please, please seek and/or accept help. From previous posts I’m confident that you would have had no problem dealing with their bullshit under normal circumstances. Clearly these are not normal circumstances. Look at your post – your insurance worries are squeezed in between the everyday (hour, minute) burdens of your grief. Its too much. I’m sure you can manage all this on your own. You don’t have to. You’re surrounded by amazing resources. Please let someone take this off your plate.

    I wish you moments of encouragement along your journey.

  2. Find yourself a good lawyer. Once the insurance company knows you have one, they’ll change their tune. Also takes most of the burden off of you and you will have an expert dealing with the issue.

    Try this link to help you find a local attorney: http://www.austinlrs.com

  3. They will always “deny” a claim at least 3 times. They hope you “give up” so they don’t have to pay. I know this first hand since I work for another large insurance company.

  4. Hits keep comings is a good title for this blog….im so sorry to hear that after all that you have gone thru that you are still having to get hit with other stuff….I just want to praise you for your writting and hope that we all appreciate it. It takes a really strong person to continue to write out his emotions, experiences with such detail. I hope that you get out of life what you deserve…..Thanks for opening up your heart and mind to us….

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