Chapter 9: The Insurance Fiasco

When the medical bills and insurance statements first started coming in the mail, I'd open them and cry. Later, as a trickle became a flood, I didn't even open them, I just stuck them in a red file folder that grew and grew until it was three inches thick.

The first piece of mail that made me cry was a statement from my insurance company informing me they wouldn't pay any part of a $1,700 bill. On the bottom of the statement they included an incomprehensible explanation of their position, but I knew it was an error. I also knew it was going to take phone calls and letters to both the insurance company and the health-care provider to straighten it out. Who had the energy? Not me.

As the statements continued to come in, I was befuddled by bills from providers I'd never heard of, charges that didn't add up, errors in the calculation of my deductible, and--always--codes and cryptic explanations that I couldn't understand.

My favorite is "Payment reduced per sanctioning policy." What's a sanctioning policy? My health insurance company, United Healthcare of Minnesota, is sanctioning me for spending too much money?

To the Rescue
Help arrived in the person of Kelly Calden, whom I found in the Yellow Pages under "Insurance Claims Processing-Medical." Kelly came to my house and didn't even flinch when she saw the stack of unopened bills and statements. "Some people give me mounds of envelopes in laundry baskets," she says. "Some people have not dealt with the medical bills for two or three years."

First, she sorted out the mess, matching statements from providers with explanations of benefits from my insurance company. She threw away duplicates, filled out forms and sent in the ones that hadn't been submitted to my insurance company. Then, she checked for errors. She found several in the calculation of deductibles, and asked my insurance company to correct them and recalculate payments to the doctors and the hospital. So far, she has saved me $630. And we're not done.

Kelly has called or written to all of my health-care providers and has a contact at each one. She's tracking everything, following up regularly by phone or fax. "I let them know we're working on it and that we're not deadbeats," she says. "It's all very positive and very nice."

If a claim is denied, she doesn't stop working. "I don't accept the first denial," she says. "I question it on the phone and if I'm not satisfied I fax a note or letter asking for a response in writing."

What I get is a list of bills to pay, complete with addressed, stamped envelopes. I also get a clear, brief status report. Kelly charges $25 an hour, and so far her services have cost me $150. She expects to put in two to three hours a month handling my claims over the next couple of months.

What'll It Be: Nausea or Fatigue?
For me, Kelly is a bargain. I barely have the energy to eat dinner, let alone sort through the insurance. My doctors warned me before the chemo started that the two biggest side effects were likely to be nausea and fatigue. I've been lucky with the nausea--I haven't thrown up once.

But fatigue, a fancy word for being tired all the time, I understand. Before I started chemo, I wanted someone to quantify fatigue. "How tired?" I asked again and again in the early weeks of my care. "Give me numbers, give me hours-per-day. Will I be able to work? Play with my kids? Keep things running at home?"

And, of course, I got the standard answer: "It varies from person to person." Which is no answer at all.

A couple tales of deep fatigue:

The Monday after my second chemo, I fell apart in public. I worked from 9 a.m. to 1 p.m., ran a couple of errands, then went to my son Robin's school for a 2:30 p.m. parent conference. The family in the time slot ahead of us arrived late, and then took 50 minutes for their 20-minute conference.

And I fell apart. I started crying, and complaining to the teacher that I was just too tired for this and it was really unfair to make us wait so long.

Then, on Christmas Eve, the day of my sixth chemo, I was too tired to open my gifts. I lay on the couch and watched the kids open theirs and left mine till morning. The fatigue can come on very suddenly. And it's hard to predict; some weeks have been much easier than others.

In between, there are days when I feel pretty normal. I have energy and enthusiasm and joy. Those moments are treasures: As trite as it sounds, the sky is bluer; my love for my children and for life is more intense than ever. Paradoxically, rest is not the only thing, or even the best thing, for dealing with fatigue. Exercise is. Just a walk outside in the fresh air, even 15 minutes, can work wonders. One of my nurses tells me, "Exercise fights fatigue, right down to the cellular level." I don't entirely understand that, but it sure seems to be true.

Waking Up
It's been a week since my six-day hospital stay for depression. The antidepressants have kicked in and I feel much better. I'm still not sleeping much, and I have trouble writing. But I feel hopeful and have more energy, despite the chemo fatigue. I can talk to people, and I have an appetite again. And I'm planning a party to celebrate the end of my chemo, just three weeks from now.

I'll continue my treatment for depression past the end of the chemo, and my psychiatrist has suggested light therapy and an additional session of yoga a week. I like the idea of adding complementary therapies to the conventional medical approach, which seems to be drugs, drugs and more drugs.

@ Jeanne Sather 2006