Friday, December 30, 2011

BLUE SHIELD BLUES

I am being very nice, honest, though at times it is not easy, answering the same questions over and over again after waiting on hold to cheery recordings of all the same tips about how to save my insurance company money.

Today is my third day of hours on the phone with Blue Shield of California member services, prior authorization, appeals, case managers, and supervisors, and who knows what and who else trying to get authorization for the Ohio State University consultation with Dr. Byrd for my clinical trial with PCI-32765.

It seems that their right hand doesn't know what the right wrist and the right pinkie is doing.

It's an appeal. It's a prior authorization, It's wrapped in with the clinical trial. No, it's back to a prior authorization. It's Super-Conflated.

After hours on hold and multiple lateral passes yesterday, I thought that when I finally got a phone number and a reference number from a case manager for my local oncologist to use with clear instructions of what he needed to do, the path was clear to a yes or no.

Boy, was I naive. His nurse got the same polite run around that I did today.

But everyone (even me), is very sweet and tries to be oh so helpful.

Remember all I am trying for is authorization for the relatively cheap mandatory consult to assess whether I am a candidate for the trial, not for the pricey trial itself. I understand quite sensibly that once it is ascertained that I indeed qualify, OSU will then apply for the trial coverage, and that is the real critical action. I am quite confident that will work out. And I am very confident that I will be in the trial by February.

I suspect, again probably naively, that the authorization for the trial itself is a more traveled route and an easier path to navigate.

This is just a fun and informative diversion in learning how the other big blue (not IBM but Blue Shield or BS) works.

The trial is the goal. I can pay for the consult, but not the trial. This is the practice run. I am keeping detailed records. I am hoping that I don't need them.

I am keeping my eyes on that prize. For a chance for real durable disease control. The excitement of a healthy and lengthy old age, a new drug that offers a true truce with my leukemia: these joyful possibilities almost get lost in these side battles.

I remain realistically confident that 2012 will be the beginning of the end of CLL struggles.

And very polite and helpful.

Labels: , ,

1 Comments:

Anonymous Anonymous said...

I think you should lobby Dr. Farooqui at NIH to amend his protocol so that people like you could be entered into their PCI study!

Good Luck

December 30, 2011 at 4:00 PM  

Post a Comment

Subscribe to Post Comments [Atom]

<< Home