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Friday, September 18, 2009

It's a Beautiful Life

Well, the Summer is over and now I'm back for one last semester of school. I am thoroughly enjoying my two classes: Personal Finance (a much needed course for me) and Business Presentations. My presentations class has been fun to present on what I want to and enjoy teaching others. I will present next on the healthcare industry and then for my persuasive presentation discuss the new Utah Health Exchange.
A miracle happened today.
I have been trying to see if I could be eligible to get my every-eight-week infusions done here at home. In the insurance world it is called "home health care". When I called IHC Home Healthcare they informed me that because I am not "home bound" that my insurance carrier, SelectHealth, would deny my claims. So some phone calls to the insurance carrier, a written appeal, waiting for weeks, and then a phone call today - they preauthorized me to have my treatments done here at home on my schedule - nothing short of a miracle. When it comes to insurance carriers they must have been having a really good day. I was expecting the typical automatic rejection and so I almost fell out of my chair at work when they called.
This means so much more to me than just getting my insurance provider to preauthorize my infusions: It means that I don't have to give up the equivalent of 4 PTO days each year just to get my infusions. It means that I dictate when I get them done, which for me will probably be in the evening when I can be with my family and not be strapped to an IV (which I will still need to have done at home) in a place where I get depressed looking at all of the patients who are getting their chemo treatments. It means that I won't have to pay to sit in a chair for 3 hours and be billed for everything from the Tylenol and Benadryl that I decline to take each time to the janitor who cleans up each evening. Yes, it will be much less expensive to have it done at home.
There will be a nurse who will do the infusions - Kari and needles don't mix no matter who is getting poked.
While I categorically don't fall under SelectHealth's typical home health care patient they did indicate that there were other factors they looked at to determine if they would approve the care. Two of those were cost and frequency. They did state that they are preauthorizing me but would only preauthorize on a case by case basis.
Lastly, I would like to express my thanks to my wonderful co-workers who are each experts in their respective fields and who urged me to move forward on this no matter what I thought the outcome would be. First to Serena and Holly for helping me understand how best to navigate the dark corridors of member services (not that member services is dark and bad...) as well as helping me through the pre-authorization process. You both are fabulous because you deal with claims day in and day out. Next, to Marisa and Kym for urging me to submit a written appeal which I believe helped make the difference in this case. You both are optimistic and helped me when I didn't think it would work. Next, to Aliece for sharing her wisdom and expertise in how to get through the insurance red tape. Lastly, to my beautiful and wonderful wife in providing me with my daily strength to continue to cope and deal with this disease and try to be a good husband and father.


shersy said...

I'm so excited for you! That is really great news :) You are such a great guy - in so many ways! Thanks for inspiring us all :)

Ginna said...

wow aaron that's super great. I'm so glad for you that it's working out! :)