Wednesday, May 28, 2008

Insurance, Insurance ... Pay Me!

A Mr. Richard Feder from Fort Lee, New Jersey writes in and asks, "Dear Roseanne Roseannadanna -- it's now Wednesday morning. How was yesterday? And what is happening today?"

The quick answers to those questions are: not as busy as I thought, and still not sure yet.

Yesterday we had our final appointment with the previously-assigned Alta Bates oncologist, which became a very short meeting once we informed him we were going with Stanford for our treatment for this case.

More importantly, we were not able to schedule the needed CAT scans yesterday because insurance, despite supposedly being on the fast-track on this, still hasn't approved the Stanford angle. I've been assured by my HR department at Sega that once the insurance company approves everything, I'll get the same benefits for the Stanford treatment that I would have received had I stayed in-network.

Unfortunately, there was a bit of miscommunication yesterday that left the approvals still up in the air, and we hope to get that cleared up today -- but now I'm being told that the approving medical group doesn't consider my situation "urgent" and won't provide approval until Friday at the earliest.

I guess if by "urgent" they mean "probably won't die today," they have a point. Unless a random bit of falling asteroid hits me, or I fling myself off a 300-foot cliff, yeah, I probably won't die today. Of course, if by "urgent" you mean "there's a big-ass cancerous tumor growing in my stomach and with each passing day it becomes more difficult to attack it and remove it," well, I'd say they're a little off. But that's just semantics, isn't it?

This is to be expected; the insurance company never wants to go out-of-network to begin with, and when you bring Stanford into the equation, you're talking serious costs. Of course they're going to fight it, but we're having the Stanford doc call the insurance group's medical officer today in order to clarify that "urgent," in this case, means "get off your bean-counting ass and approve the treatment ASAP so we can save this guy's life right now." The accountants might not think it's urgent, but I'll tell you this: Kuato ain't getting any smaller, that's for sure.

So that's where we are on that. Several calls will be made on my behalf today to try and speed this up, and we'll just have to see where it goes. Once we get approval, Stanford should be able to handle everything else without much hassle, but getting the approval is proving to be a real pain in the ass -- but it's not like we didn't expect this.

I also have an appointment for tomorrow morning to, um... putting it vaguely here... ensure that I can still have a child in case any sort of cancer treatment leaves me sterile. So if Jessica Alba or Evangeline Lilly is out there somewhere reading this, just know that I'm already thinking about you fondly.

(Which is not to be confused with 'fondling.' Or maybe it is. You decide.)

Keep the positive thoughts and prayers flowing and we'll get some movement on this soon enough. I love all the emails and phone messages, and all the comments coming into the blog are great -- I read every one, and am amazed at people that I don't even know (like Francesca) that are writing from across the globe to lend their support. I still have no doubt we're all going to crush this thing -- me, you and everyone else that has kept such an amazing positive outlook on all this. There are going to be roadblocks like this insurance thing, but we'll get there.

Good things come to those who wait (but not too long)...

With much love,


Lisa said...

This is a temporary roadblock but not an insurmountable one. Thank goodness you have such a team advocating for you.

During nursing school one of my professors at UCSF told us "when you are the patient, you need a bulldog with you at all times." And, she is right. The wonderful thing here is you have a whole pack of bulldogs on your side. xoxo Lisa

Francesca Giessmann said...

keep pushing and don't be afraid to be a pain in the $#%@... just always be polite and (try not) loose your calm.. but KEEP PUSHING... it is your health ... and you have to be the biggest BULLDOG... Also I am sure your cancer San sei told u already but start keeping a log ( not a blog!) , something like a big fat binder with all that has to do with your illness... from all the insurance shit to all doc appointment.. to all blood work.. you will think that you will be able to keep it all in your head or semi-organized...IT WONT work.. get a big fat binder ( it can be the livestrong) one and get tabs and carry that everywhere... I was treated in top of line cancer center but let me tell u that more than once I was the one that gave a nurse or ER doctor a piece of info FROM MY BINDER ...
OWN your treatment.. THIS IS THE FIGHT OF YOUR LIFE... ask tons of questions ...
As I said: HARD BUT DOABLE....
much love from way across the other pond...

Trent Stamp said...

Normally, I would say that I'm thinking of you, but I'm going to do my best NOT to think about you tomorrow morning, thank you very much.

I'd say "good luck" but I'm pretty sure you've got a handle on that particular aspect of the process.

Andi said...

If I were on TV or radio, all you would hear would be "those BEEEEEEPPPPP, god beeeeep, beeepers, stupid, mean, beeeepholes"

Keep pushing!!! Like you've always said - you are not a number or a study - you are you, Dino Scoppettole.

JNev said...

Dino, I have the utmost confidence that you'll be able to beat this thing and beat it down just as in your dream, which I was interpreting the same as you did as I read it.

With regards to Insurance, I actually work in it. No, I don't work for an insurance company but I do deal with medical claims on a daily basis. Keep fighting the medical groups and don't let them tell that it can't be approved. Yes, they are a royal pain to deal and hopefully you will find that one person who is willing to go the extra mile to get it approved.

By the way, I still talk about your stellar announcing skills during my little league baseball games back in 1985 -1987....?

Much Love,

Lil Nev (although I'am a little taller and slimmer than the Elder Nev that is my brother)
AKA - Jason Nevin

MikesDad said...


This is Mr. Nev (as opposed to Elder Nev and JNev who as you know are my my two sons). I second what Jason says, keep up the good fight. We are all behind you and wish you a speed recovery. And, as I said in my email (before I figured out how easy it is to post to you blog) we will send you our address so you can come by and TP the house for old times sake.

The real "elder" Nev...

Looney said...

F*** the insurance companies!
F*** the insurance companies!
F*** the insurance companies!
F*** the insurance companies!
F*** the insurance companies!
F*** the insurance companies!
F*** the insurance companies!
F*** the insurance companies!
F*** the insurance companies!
F*** the insurance companies!
F*** the insurance companies!
F*** the insurance companies!
F*** the insurance companies!
F*** the insurance companies!
F*** the insurance companies!
F*** the insurance companies!
F*** the insurance companies!
F*** the insurance companies!
F*** the insurance companies!
F*** the insurance companies!
F*** the insurance companies!
F*** the insurance companies!

I hate 'em...

Michael Nevin said...


Nev the first here. Jason called me yesterday and told me about your recent diagnosis.

I'm sorry to hear about it. I know we have not spent any time together since my wedding (which was 15 years ago!!!) but I still think of you as my friend and do think of you often.

I will be praying for you.

By the way, my brother may be slimmer but he ain't as good looking as this preppy, jock, babe (yes I humiliated myself on the blogosphere so that you could have a good chuckle)!

Amy said...

Dino Dino Dino! How lucky are you? Not one, but TWO cancer senseis. That is something to be proud of. I didn't have one. I don't think Francesca did either. But we found each other (she found me, and I am soooooo grateful!) and now we get share our experiences and knowledge with you in hope that it can be a little easier for you. Today, Francesca took the words right out of my mouth. Sadly, to the insurance company, you're just a file on their desk. A name on the subject line of an email. They don't know who you are and they don't have to say no to your face - so it is easy for them to do. It is really F'ed up. When they told me I had an abnormal chest xray that showed lumps -- I freaked. Well, I EFFIN FREAKED even more when they said they could schedule my follow up CT Scan 3 weeks later. I called them, politely yet tenaciously, and said, I am coming to your office every day and staring at you and asking you every 30 minutes if you can squeeze me in for a CT scan. It will be awkward for all, and to avoid it, all you have to do it squeeze me in the schedule. They called back 2 hours later and suddenly I had an appointment in 36 hours - a lot better than the 3 weeks they originally quoted me.
No one cares about you more than YOU. Make them care. Make them respond. Ask them the hard questions. You're paying them, MAKE THEM WORK FOR YOU.
Wishing you a peaceful night of rest.
Pain, fear, and defeat do not exist in this dojo.
Love, your American Sensei. Your Swiss Miss Sensei Francesca is pretty awesome ya know! She kicked major cancer ass. She was Stage IV!!

Dino said...

I bow to my cancer senseis, Francesca and Amy. Will you show me how to do The Crane move? I'll need a new move for the arsenal, to add to the 'wax off' move I'll be using tomorrow morning.

smrose said...

Really Dino, you've been preparing your whole life for tomorrow morning.

philo2 said...

relax and aim for the center. I have total confidence in you.


LynnAJ said...

big DITTO to what Francesca recommends -- keeping the notebook/binder, or having your mom do it, as your advocate. when my little sis was in the hospital, it really helped to have my mom or me there with all the pertinent info that sometimes was overlooked, forgotten, or not kept in order by the overworked and ever-changing shift-staff. dates, times, names, numbers, every detail you can record for yourselves will help YOU be in charge of YOU!
on a lighter note, i hate to admit this--as i read every blog (just to catch up since Lukie just sent me your blog address) tonight, Steve Perry's (Journey) voice keeps ringing "Don't Stop Believin'" in my head (for whatever that's worth) i send you all our love and gratitude for being in our lives and feel indebted to Luke for introducing us. You are an amazing person (but we already knew that)...You inspire me!
Love, Lynn (and Corey sends his best from Houston)