Dave update! and insurance gripes.

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Here it is, the post you have all been waiting for.  Or at least may be interested in.

Dave had yet another appointment with the surgeon on Monday.  And again, the news was better than we could have hoped. 

Clean margins around the tumor and now normal scar tissue means that the critical stuff is all done.  There will be no need for even radiation.  Amazing. 

So what’s next?  Near constant follow up.  But hey, that is great.  Dave will be in for various scopes and visits a couple more times before the end of the year and then will have to have colonoscopies every 6-12 months for a while and depending on the outcome of those, perhaps moving to 18 month intervals at some point. 

Now about the insurance, stop reading here if you are short on time.

Now if we could just get the insurance company to agree all this was needed.  It looks like we will be fighting with them every step of the way.  I guess that is why we get to pay $300+ monthly premiums for complete coverage, so they can reject nearly everything and make us fill out endless appeal forms and spend hours and hours on the phone trying to convince the company that it really was a good idea to remove a cancerous tumor. 

Right now we are looking at $5000+ that the insurance company is saying they will not pay.  This in addition to the $5000 that is our “out of network” deductible that we are asked to pay since there are NO preferred providers for colo-rectal surgery in the entire state of Alaska.  The nearest in network group is in Seattle.   Hmmm, can’t imagine that the cost of plane tickets and hotel rooms would have been less. 

To be fair, I need to say that the insurance has paid about 60% of the after deductible costs, but really, this is a chunk of change.  So much for the dream of a savings account. 

I am hoping that with enough appeals and a little pressure from the surgeons group and with the help of the insurance-liaison that Schlumberger employs, that the insurance company will relent and agree that it really was a worthwhile thing to remove this tumor.  The irony is, if we would have caught this later, or waited the 6-8 weeks for this tumor to continue it’s growth and change and  if Dave would have needed radiation and chemo, there would have been no question regarding payment, even though it would have 10’s of thousands of $$ more than the cost of the surgery and followup. 

I am thankful we have insurance, I am fully aware of what a luxury this is, and I am thankful that we will be able to pay, not right now, but eventually we will certainly have that bill cleared, and I am so thankful that Dave has a job that pays enough to make all that possible. 

It is a reminder, however, of the millions of people for whom this would truly be a tragedy.  For whom the thought of $10000 would not be just depressing, but paralyzing.  I am SO thankful that Dave did not go through this when I was the one working and he was in school.  For a number of reasons, but primarily because $10000 would have been more than 1/3 of our yearly take home income.  There are alot of hardworking people for whom this is the reality.  That sucks. 

 Obviously the system is broken, I don’t know how to best fix it, but I would like to see more dialogue on this.  Because it is not just the professionals with company insurance who get sick, but also those people working a trade for a small business that can’t provide the same coverage we enjoy.  The self employed get sick too, and it is increasingly hard to find coverage for those 2,3, 4 person operations that make up so much of America’s workforce.  

I have several friends/family who have had to make the choice between insurance and essentials.  In most of these cases there have been economic thresholds that they (thankfully) slid under and at least the kids can get coverage through a state or federal program.  But, this still leaves (in at no fewer than 4 cases I know of) the mama without comprehensive coverage.  All the families I am thinking of have catastophic coverage for the mama, after a huge deductible($5000, which is a HUGE percentage of their income). Which means mama doesn’t go to the doctor for the preventative stuff, or regular screenings, the visits that could catch an illness BEFORE it is catastophy.   These are hardworking families, taking every bit of overtime offered, working 2 jobs, watching the grocery costs pretty carefully etc. 

I guess in the meantime, I will keep praying for their health.  And thanking God for my own.

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About Sandie

A little background: A mother of 3, two boys and a girl. Married young to a good man. No longer young, but he is still a good man. Grew up in the suburbs of Minneapolis, lived several years in small town Alaska, spent a couple years in the city of Madison, currently residing not too far from down town Anchorage. Drink a crazy amount of coffee. Fiercely loyal to my friends. Truly rabid in my defense of family. Beyond thankful that my God loves me enough to allow me to doubt and question.

2 responses »

  1. Yup, our insurance company is changing next year. No big surprise, but premiums are going up. Sheesh.

    Sooooooooo glad that Dave is doing well!

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