Friday, September 2, 2011

Are You Covered?

Every website, piece of literature, or document devoted to cancer and cancer research that I can find says the key to beating cancer is early detection. In my case, financially, early detection is what hurt me. If I would have waited a little longer to go to the doctor, and let the cancer spread a little more, apparently, I would have been covered.

There are four positions at my place of employment that are covered for Long Term Disability (LTD) and I am lucky enough to have one of those positions. You must have been in the position for one year before you are eligible for coverage. The coverage is for 50% of your wage so you're certainly not making money while on LTD but after sickness benefits runs out, LTD kind of picks up where you left off.

I considered myself very lucky to be able to go through a mastectomy and chemo and not have to work through it. I know many people do it (I'm not sure how) but it was very comforting to know that I wouldn't have to work and worry about throwing up at my desk, risking infection due to my immune system that has had the crap kicked out of it or falling asleep in my chair because of chemo.

I had been in my position for a year as of December 2010 and so when my diagnosis was March 11th, 2011, I knew that I was not only eligible but also qualified for LTD.

So, just to be clear, here are some dates;

Sept 2010 - family doctor found a lump
-assumed it was Fibroadenoma (my mom had it at about my age so it was a safe bet)
-ordered an ultrasound

October 2010 - had ultrasound done
- the film was blurry so a 2nd ultrasound was ordered

November 2010 - had ultrasound done
- showed mass (the same mass I could have shown you if I took off my bra)
- radiologist said "I'm 99% sure it's nothing but come back in 3 months so we can monitor it."
- 'Cancer' was never mentioned / nothing on the film indicated cancer

January 2011
- Saw a doctor for a consultation (it's procedure for anyone who has found a lump)
- (verbatim) She said 'Don't worry, you don't have cancer.'
- She said it was again, most likely fibroadenoma

February 2011 - Had the 3-month check-up ultrasound
- I also had a mammogram done
- At this point, they wanted to confirm that it was nothing so a biopsy was ordered

March 1 2011 - Biopsy was done

March 11 2011 - Diagnosis of Breast Cancer

March 19 2011
- Confronted the surgeon who said I didn't have cancer by saying I was given false hope and we need to be on the same page from here on in
- Told her that I wanted to trust her as she was the one doing the surgery and I would have resented her if I didn't confront her for saying I didn't have cancer
- She agreed, appreciated that I brought it up, and we moved on

So, I filled out all of the information for the insurance company which my oncologist charged $35 to fill out. I sent the forms away at the start of July to ensure that there wouldn't be any delay in payment. My sickness benefits ran out on July 23rd and so two weeks later my LTD was supposed to kick in.

I got a call mid-July from the insurance company asking a few questions about my diagnosis. I filled in all the blanks for the rep on the phone. After not too long, she explained that they were going to try to prove that it was a pre-existing condition and deny the claim.

WHAT? But I was diagnosed in March and I qualified in December?

She also asked if the side effects of my chemo were difficult to deal with and wondered if I had a good support system. What difference does that make? Does it help her to sleep at night if she knows that I have a good support system? I never found out what basis those questions had.

She also wanted to know my highest level of education because I not only had to prove that I am not capable to complete the job that I had when I left, but I have to prove that I can't do any job. Well, the last time I checked, there isn't a job out there that prefers you to both puke and poop your pants at the same time while trying work.

Anyway, after not hearing anything for a month, I called on last Wednesday and left a message asking for her to call me back. She called me on Thursday to tell me that I had been declined. So, even though there is no test that showed cancer prior to the biopsy in March (I'll even say the mammogram showed reason for concern in February), you are declining my claim because I had a pre-existing condition prior to my one year being up?

While I had her on the phone, I asked about the appeal process and she said the information would be sent to me along with the write up explaining the reason for it being declined. I also asked her for the legal department's contact information because if someone knew that I had cancer in September and withheld that information from me, and I am still going through chemo a year later then someone needs to be held accountable. The woman from the insurance company said that no one in particular said that I had cancer in September but because diagnostic tests were used, they are arguing that I had a pre-existing condition. Well, you can't have it both ways, you can't say that no one is willing to say that I had cancer prior to my diagnosis but you're declining my claim because I had a pre-existing condition called cancer.

She is saying because there was a lump that means that I had cancer. Why then did my surgeon say 'Don't worry you don't have cancer', and why then do women, who have biopsies on lumps that are benign, continue to be monitored? Because, benign lumps can turn into cancer. There is no proof that the lump was malignant in September. I had a pre-existing lump, I did not have a pre-existing condition. In September, they weren't looking for cancer (which they didn't find), they were looking for anything. I was given pamphlets on Fibroadenoma in January because that's what I was told I had.

I've had to go back through my journal to look up some dates for this entry. Keith was good enough to get me a journal in the very beginning so I could document my 'journey'. I found some entries where I commented on how lucky I was to have LTD and that I wouldn't have to go back to work too early and risk burning myself out or risk infection because my immune system just wasn't ready for me to be working again and yet look at the situation I'm in.

I still have another surgery ahead of me; it's for my implant, so I can have a right breast again. I know insurance companies don't care about things like that. They look at the bottom line, they look at loop holes and saving money, regardless of who suffers. What's frustrating is that insurance companies give an illusion of caring and taking care of their clients, they are supposed to be about families, and supposed to protect you when you need it.

The sad thing is, at most, I would get no more than $12000 over 5 or 6 months. It's not like this was for millions, and it will still be challenging to pay rent, and OSAP and groceries and bills; it was enough to keep us afloat. It was enough to keep me from going back to work too early. It was enough for us to not go into debt at 27 years old on top of having cancer.

Chemo graduation day is next Friday. I made it, as hard as that is to believe, I did it! All six treatments will be behind me as of Friday afternoon and then it will be time to heal. Unfortunately, I fear that I will have to return to work early because financially, we cannot afford to have one income for much longer.

I am waiting to find out about the appeal process (which I'm sure will take months) and will be somewhat costly and then I will take the next step. As my Dad said, "you only have so much fight in you, and you should be focusing on your fight with cancer not with insurance companies." Insurance companies get away with so much, and it always seems to be the honest guy who pays. I also want to be clear that it's not my place of employment who's to blame either, they have been great! They may want to reconsider their insurance company when the renewal for the contract comes up, but they have been great with me having time off and supporting me through this whole thing.

Before you pay another penny into your insurance, I'd make sure that you are covered for what you think you covered for.

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