Monday, April 23, 2012

Appeal?

So today I found out that, even though I called in JANUARY to be sure there was no co-pay for my Herceptin treatments, that there actually IS. I had even spoken with them a month ago and they have been "looking into it". The lady last month checked everything and agreed with me that I should not be paying anything more than a $5 injection co-pay. They are charging me $55. She had no idea where the $50 was coming from. So, 4 weeks later I get a letter saying no, it's correct. I called today and spent probably over an hour on the phone with "Dixon" (who was very polite and helpful, I might add, even the times my voice did get a little squeaky). Seems it's buried under "pharmacy". Yeah, even though the lady in the pharmacy department agreed that "pharmacy" means you get a little slip of paper, go into the drugstore and trade that for a bottle of something to take home with you. The Herceptin is a Class 3 pharmacy which has a $50 copay. (ooh, just a thought - a co-pay at the drugstore is supposed to be for a months supply so I COULD try it from that angle if nothing else). I should be lucky it's not Class 4 which would mean I would have to pay up to $3500. Yikes! I am missing Cigna more and more. Every time the word Humana crosses my mind. Blah. I digress. The bottom line is that, buried in the bottom of a bunch of phraseology 'n crap I don't understand even though I used to make my living doing Dixon's job, is the fact that there is indeed a $50 co-pay. Which I was told specifically, when asking that exact question TWICE, that there was not. Which, having been told specifically that there was NOT - I should appeal. Dixon told me exactly what to do. "Maybe" they will write it off, at least up to this point. I am not going to hold my breath. So, we all know I was conflicted about Herceptin anyway. I was planning all along to stop early - just hadn't figured out HOW early. I've been practically obsessing over it lately. When I got the letter, I decided to give it one last try and that would make the decision for me. $50 doesn't seem like a lot of money, does it? But -- 16 weeks of Herceptin so far is $800 that I don't have, that I don't know how I'm going to pay. That I will HAVE to pay anyway, if I don't win the appeal, even though I was specifically told not once but TWICE that I would not have to. Isn't that crazy? I have 24 more weeks to go if I stick to their schedule. That's an additional $1200. Total $2000 that I would not have had to pay under Cigna. That I was told-not-once-but-twice would not have to. Of course if we KNEW it was doing any good it would be a different story! But we don't, and we've gone over the studies, and the agendas of the drug companies and the pink people. Knowing that, and having read all the studies about side effects and heart damage, and knowing that I have 2 kids in college next year and -- I think I know everything at this point -- no. No, thanks. So I'll write the appeal letter and see what happens. I was skipping this week anyway to go on a field trip. I may go on in next week and talk to the doctor about it. Maybe get one more for old times sake? ha. Did I mention how tired I am of living in fear? Well, I still am. I am SO F'ING TIRED of it. I have not been a fearful person in years. I don't want to be this way. I'm afraid to stay on Herceptin and afraid not to. So I asked God to give me a sign. This is it. Stay tuned...

No comments:

Post a Comment