Stem Cell Transplant ( Sct )

[Lady of Longbourn]

You are an amazing person, Debbie.

Please keep writing and keeping us updated.

 

[nimkekaa]

Thinking of you and wish you all the best during your healing journey! Big Hugs

 

[intothelight]

When I met with my transplant doctor, I found there are three medical centers in this area that do SCT. Of course I pick the one that my doctor practices out of, which is also the closest to my home. Yesterday I received the news that my insurance company considers the one facility out of network and I would be responsible for 50% of the bill with no cap.

It is really difficult to explain the impact that being forced back into a corner at this point has. There are only two options as I cannot afford to pay out of pocket any more than I am already faced with. I can appeal the decision and have "in network" benefits awarded or I can go to another transplant facility.

For many reasons I do not wish to go somewhere further away and especially lose my medical team at this point. Although they will be there before and after, but I know this procedure will take up the next six months of my life. That is a long time, and this time I am fighting by doing an appeal.

Funny this hospital I have treated at since the beginning and it hasn't been "out of network" for anything else. In fact, if I was having a heart or kidney transplant it would be "in network". A part of me understands the other centers are larger and have entire special units dedicated to this procedure. I know this facility has a very small transplant program as they are just starting to expand into this area. It really boils down to dollars and the greater the volume, the greater the discount for the insurance company. For the hospital, it isn't an issue of taking the insurance company's contract price as they know I cannot pay the difference. They've already written off a huge amount of my medical as it is. It isn't also about the quality of care, for as far as this type of procedure goes, this is the safest one there is. I feel caught in the crossfire.

So I will appeal, and at the same time I have picked a second facility. If I lose the appeal, I will proceed with this facility. At this point, either one is fine from a medical standpoint. But for me, the psychological impact of loosing my medical team at the biggest turning point in my treatment is a road I do not want to go down. Anyone would be stressed by this, but PTSD just makes it harder to handle in some respects.

On second thought, does PTSD make something like this harder to handle, as it really would suck for anyone. No one should be in the position of facing cancer and losing their doctors after nine months of treatment. No one.

 

[Froggie]

I find this sad that you have to go elsewhere in order to have "in network benefits", and I fully agree with you that it is unfair to lose the medical staff in which a bond of confidence has been created over the time. I'm asking the univers that they send you to the appropriate place where you will feel confident in the staff.

This situation is certainly triggering something in your PTSD, that is what I've been noticing in my case. There are subtle triggers with the cancer situation that have an impact on my mental health. There are times it's the PTSD that has an influence on my cancer situation, but it's more the opposite that happens. One way or another, sure keeps a person busy with 2 major diagnosis.

Best of luck to you ((((Deb)))) you are a model for many, including me.

 

[Deleted member 12723]

I am sure praying that this can be worked out to your advantage. You have worked so hard. This would make me very frustrated and very angry. This is a big blow to your recovery process and must trigger your ptsd something fierce.

You can only do your best. I hate organizations that have such power and control over a person. I hate the by the book people. I wish you had a advocate in their system that could see and hear and be in a positon to help you. I would go through the system looking for an advocate, mabe human resources. It is a place to start.

You know more about this stuff than I do so throw my words away if they are useless to you. I hope you find many creative ways to release your frustration and anger. Much love and prayers.

 

[CraftyCath]

I hope it all gets sorted Deb.

I don't really understand how medical insurance works as we have a National Health Service in the UK.

Keep us posted.

Blessings,

Cath x:hug:

 

[Deleted member 12723]

(((Deb))) I am keeping you in my prayers and thoughts. I sure am crossing my fingers that you get to keep your medical team. I always hope for the best for you. Take really good care of yourself. Big hugs.

 

[Icon Nikon]

Deb,

I gather I do not have to say much for you to know that I DO understand exactly how disturbing and absurd this is.

And yes, the facilities may be equivalent in care, but the loss of continuity of care means wasted energy repeating things and just the whole "I feel reassured with the team I have in place", especially when viewed not just through the lens of cancer but the lens of PTSD.

I applaud you for being that champion fighter and appealing this, but more so I think you are wise to move forward with both the appeal and the second choice location. Your mind does need time to accept that that may be your only option.

With that said, I have in fact argued in the past to get a medical professional to be accepted as a one-time in-network provider. One time it was based on their expertise in a medical specialty (which of course does not apply here) but the other time was based on their "expertise in the specialty of me" - all those little medical and mental aspects to care that cannot be relayed through some "medical file"...as I have yet to see someone stuff an entire person into that one folder (LOL).

But an appeal can work if you exploit the rules in your favor, and well I truly hope you DO win, if only for your own peace of mind.

United in uncertainty and strength,
Alex

 

[intothelight]

I won the appeal! I get the hospital that I wanted, as a one time "in network" exception. (Hopefully, I won't need a second time for a long time.)

I meet with the transplant coordinator on Thursday. I can't say that I am excited...really, the closer the time draws nearer, the more afraid I become. Keep getting the weird thoughts about "how this could be the last time I do....". Need to keep this kind of stuff out of my head as I am just stressing myself out unnecessarily.
I am happy I get to go to the hospital that I wanted to, but I am dreading the procedure.

 

[Lady of Longbourn]

That's great about the appeal Debbie! :)

 

[The Albatross]

Wow that was fast! Glad you got approved and can keep your current medical team Deb. :tup:

 

[JustBe]

Wahoo! :D