The Assertive Cancer Patient

Seattle Cancer Care Alliance Bills Dead Woman

A friend sent me the link to this story in the Seattle Post-Intelligencer (actually, several friends sent it along). I can't say that I'm surprised, because I had a lot of problems with the billing office at SCCA during the years I was a patient there.

The bill that Thomas Smailus keeps getting is for a procedure that the medical bureaucracy insists took place in June 200 --four months after his wife died, the story says.

"At this point it's gone from painful to comical," Smailus said last week in reaction to receiving his fourth bill for the procedure that wasn't.

Here's the story: Wife dies but new hospital bills keep coming

Meanwhile, among our own circle of cancer blogger friends, Amorette has been hassling with insurance problems--and was told that she couldn't possibly be on Medicare, "because Medicare is only for old people"!!!

Amorette wrote on her blog: I tried to explain that I was disabled, on Medicare, and that the state insurance was intended as a supplement. He explained with much patience and derision that I needed to learn the difference between the state health plan and Medicare, that he was certain I was mistaken about having Medicare, that Medicare is for old people.

Go to her blog to read the entire post:Thanks, everyone....

Another one of our cancer blogger friends was not able to start treatment as scheduled because of problems with an insurance company. Hard not to feel very cynical when you hear these stories over and over again.

@ Jeanne Sather 2008.

Another Letter to Swedish

I seems to be a day for letters, not just mine, but Younger Son's beautiful letter to Seattle Prep, protesting proposed changes to the Matteo Ricci Program, which he is enrolled in (making him a freshman at Seattle U and also a senior at Prep--he will receive his high school diploma this spring, at the end of his freshman year of college).

Anyway, I need to send a letter to the head of the Swedish Cancer Institute about the practice of the billing office at Swedish of leaving prerecorded phone messages that do not identify the caller as Swedish Medical Center.

Not that he answered my last letter, but here goes:

DATE: April 17, 2008
TO: Albert B. Einstein, M.D., Executive Director, Swedish Cancer Institute
FROM: Jeanne Sather, cancer patient
RE: Practices of your billing department

Dr. Einstein, I am wondering if you are aware that your patient accounts office is calling patients, like myself, and leaving recorded messages that do not identify the caller as being from Swedish Medical Center?

I have received two calls to date, on April 10 and again on April 15.

The prerecorded message asked me to call the "patient accounts billing office," without telling me the name of the hospital or other provider that was calling. The number I was asked to call was 1-866-365-2211, which I have since confirmed is a number belonging to Swedish.

It seems to me that this practice is unethical. It is certainly annoying--how can I be prepared to return the call if I don't know who I am calling?

I have publicized this practice on my blog, and I will be sending a copy of this letter to the Better Business Bureau.

Links to my blog:

Here's a New One: The Blind Billing Call

Another Blind Collections Call

See also, my earlier letter to Dr. Einstein, which he never answered: 15 Phone Calls

@ Jeanne Sather 2008.

A Letter to Swedish Medical Center

I have in front of me a bill from Swedish Medical Center (although they want me to write my check to Swedish Hospital, and then there's Swedish Cancer Institute ... but anyway) with a date of service of 8/27/2007.

The "service description" is "on-going patient care," and I supposedly owe $75.18 after my insurance paid $3.02 and there was an "insurance adjustment" of $57.80.

Well, my first question is what the heck is "on-going patient care"? Is that a doctor's appointment? And, if so, with which doctor? I've seen two different oncologists at Swedish, plus the various doctors who read my scans who I never meet.

The bill puzzled me for several reasons: The most important of these is that once my annual deductible of $1,000 is satisfied, I don't owe anything for care I receive at Swedish, because it has a preferred provider relationship with my insurance plan, WSHIP. I generally meet the deductible by February every year, and don't owe anything after that. Since this bill is dated August of 2007, I shouldn't owe anything.

So I called WSHIP, to see if they could shed some light on this, and I talked to Jackie, who was very helpful, as always.

I gave Jackie the date of service and the amount of the bill, and she said that WSHIP has no record of a claim for that amount with that date of service coming to them for payment.

OK. Hum.

She said I did have a bill from Dr. Eulau, my radiation oncologist, with that date of service, for $191, and that claim was paid.

Looks like a mistake to me.

Here's the letter I'm mailing to Swedish today:

DATE: April 17, 2008
TO: Swedish Medical Center, Patient Accounting Customer Service
FROM: Jeanne Sather
RE: Bill with date of service 8/27/07 (see attached)

I believe that the attached bill is in error.

I called my insurance company, WSHIP, yesterday, and spoke to a woman named Jackie. She told me that WSHIP has not received a claim from you for that date of service in this amount.

She said there was a claim from Dr. Eulau, my radiation oncologist, with that date of service, for $191, and that claim was paid.

The bill also does not say which doctor's services the bill is supposedly for, and I would like an explanation of the term "ongoing outpatient care"--are you saying that I had a doctor's appointment on that date?

In any case, feel free to call WSHIP for confirmation.

As far as I can tell, I do not owe this amount, and I will be sending a copy of this letter to the Better Business Bureau.

I'm also sending a letter to the head of the Swedish Cancer Institute complaining about the blind billing calls his staff is making.

See: Another Blind Collections Call

@ Jeanne Sather 2008.

Another Blind Collections Call

Last week, I had a voice mail message, a prerecorded message asking me to call a "patient accounts billing office."

I had another message today, again asking me to call the "patient accounts billing office," without telling me the name of the hospital or other provider that is calling me. It may not be the provider at all--it could well be a collections agency. (I'm more suspicious after watching "Maxed Out," which shows some of the dirty tricks collection agencies use.)

I did write down the number though: 1-866-365-2211. Anyone want to give them a call and find out who it is?

As far as I know, I don't have any unpaid medical bills. I do have one bill from Swedish cancer center I need to sort out, because the date of service on the bill is not correct. I'm going to double-check it with my insurance, WSHIP, and then send Swedish a letter, telling them that it is fraud to send a bill with the wrong date of service. And maybe I'll CC the letter to the Better Business Bureau--do hospitals fall under their umbrella?

See:

Here's a New One: The Blind Billing Call

'Maxed Out'

@ Jeanne Sather 2008.

'Maxed Out'

I just finished watching a really excellent documentary called "Maxed Out" about America's debt, both personal and national. I was, of course, watching it to see what it had to say about serious illness and bankruptcy and debt, and there I was disappointed.

Although it was obvious that some of the people who appear in the documentary got into financial trouble after the death of a spouse or a serious illness, very little attention was given to this aspect of bankruptcy.

However, one expert on bankruptcy who was interviewed at length, Elizabeth Warren of Harvard Law School, probably has the information I'm seeking, and I'm going to look for an e-mail address for her tomorrow.

One thing we Americans take for granted--that if you have cancer or another serious illness you are probably going to have to file for bankruptcy and may lose your house--is not taken for granted by people from other countries such as Canada and the UK. Or Germany.

In the United States, we seem to have a very Darwinian approach to economic survival: If you are sick, well, you somehow deserve to go down the tubes financially, and then socially, and then in every other way.

@ Jeanne Sather 2008.

Here's a New One: The Blind Billing Call

I had a voice mail message this morning, a canned message asking me to call the "patient accounts billing office" at some 800-number.

But here's the catch: The message didn't say WHICH patient accounts billing office. Which cancer center?

I probably have eight different providers (billing jargon--doctors are providers, so are all the places I go for tests, like Via Radiology), so how am I supposed to know which one is calling me so that I can be prepared when I call them back?

Obviously, they don't want me to know.

Is this a deadbeat call? I love those--"We have sent you to collections and we are going to call all your neighbors and tell them you don't pay your bills." I had one of those once, but it was from a credit card collections agency, not a medical center. Credit card companies are foul, but if you have cancer you probably already know that.

Delete that message. If they want me to call them back, they need to tell me who they are.

@ Jeanne Sather 2008.

What's the Story in Florida?

OK, I hate to think that after all these years I'm still a bit naive, but I have never personally known anyone who has been refused cancer treatment because they couldn't pay for it or didn't have insurance.

I have heard stories--mostly passed on by nurses, not patients--of oncologists in private practice refusing to take Medicare patients (more shame on them) so that these patients have to get their care at public facilities, like the University of Washington Medical Center.

But flat refused to treat someone who didn't have enough insurance ... I have never met anyone in that situation.

So then comes the following comment, posted to my blog: "Where can I get help for my cancer bills? I have done the same as you, but my bills sre getting worse and in this state they refuse you if you can't pay."

Of course, I e-mailed her to find out where she lives, and she said FLORIDA.

I don't know what kind of cancer she was treated for, but she says, "My fear is also that my insurance will get cancelled because I will not be able to pay for it if I get laid off and things are looking bad at work due to the housing slump and rise in gas prices."

If you are laid off, you will be able to continue your health insurance for 18 months through COBRA, so if this happens, be sure to ask at work about COBRA. It will be more expensive, because you will have to pay the entire premium yourself (including the part that your employer was paying).

"The doctor that refused me was Dr. Kamal in Ocala, Florida. Then I cried and had them recheck and they said that they did not realize that my insurance was paying 100% and I could go ahead and receive treatment."

No comment on that one. Dr. Kamal? Want to defend yourself?

"At the end of my treatment we went in to get hopefully good news and all they could talk about was a $10,000 bill that I owed them and lead me to believe that I could not receive any other treatments until this bill was paid. I came home and called my insurance only to find out that they had been paid every penny.

"While in that office, my husband and I finaly asked, 'Was I in remission or not.' And the doctor said, 'Wait a minute, let me go back and get your file.'"

Unbelievable. She did say that she has changed doctors, which sounds like a good idea.

I'm in Washington state, which is just about as far from Florida as you can get and still be in the Lower 48, so I'm asking cancer patients and family members in Florida: What's been your experience?

Is it true that people are being denied treatment because they can't pay for it?

@ Jeanne Sather 2008.

Medicare: Ever Closer ...

During my meeting with Leah, Wonder Woman Social Worker, yesterday, she suggested that either WSHIP (my present health insurance) or Basic Health (a state program for low-income people) would have a supplemental policy that might work for me once I go on Medicare.

She also said that the private companies that sell supplemental policies to people aged 65 and older on Medicare would probably not sell me a policy--they refuse to insure disabled people who are on Medicare. (That's a loophole the federal government should close, but that's another post for another day.)

So I went to the WSHIP Web site, and sure enough, WSHIP has not one but TWO plans for people who are on Medicare.

Duh. I never even thought to check.

WSHIP has a Basic Plan

And a Basic Plus Plan

It looks like the Basic Plus Plan is the one I want. The monthly premium will be $312.60.

So do the math: $98/month for Medicare Part B, $312.60 for WSHIP Basic Plus, and an unknown amount for Medicare Part D, the prescription drug coverage. But say it's $50/month. That's about $460/month, which is less than the $777/month I'm paying now for my WSHIP coverage.

So I'll save about $300 a month, which is great.

Now I have to figure out which Part D plan is right for me. A search on the government Web site turned up 50 or so plans that I can choose from. I started checking formularies, to see which plans would cover the drugs that I take regularly, but gave up after about 15 minutes. It's too complicated.

I'll come back to it another day. Another option is to check with a pharmacy and see if they can tell me. A friend told me that Walgreen's pharmacy has a computer program that allows them to check for the best Part D coverage depending on the drugs you take regularly.

I don't usually go to Walgreen's, but maybe I'll stop by and see.

I also need to call WSHIP and see if I can change plans over the phone or if there is paperwork involved. I'm betting on a paper application. I also need to find out how long it takes them to switch me.

I haven't received my Medicare cards yet, but should within the next few weeks. And my WSHIP premium for January has already been taken out of my checking account. It'd be nice to start the new plan in February, but I'm (mentally) prepared for it to take longer.

This is the government I'm dealing with, after all.

Read more:

Medicare: Getting Closer to the Answers

Medicare Questions

Medicare Help

Tykerb and Medicare

Support this blog:

@ Jeanne Sather 2008.

Don't Dump Those Drugs!

I was outraged when I read that the government recommends that people who have leftover prescription drugs mix those meds with dirty kitty litter and throw them in the trash. (See An Alternative to the Government's Kitty Litter Drug Disposal Plan)

It seems to me that there should and could be a legal way to pass these expensive meds on to people who need them. And it turns out there is. The magic words are DRUG REPOSITORY.

A few states have them, and a few more are working to set them up.

In the state of Wisconsin (three cheers for Wisconsin!), for example:

Cancer and chronic disease patients may donate unused or discontinued medications and supplies to a participating pharmacy or medical facility. Those items will be given to individuals with cancer or chronic disease that do not have insurance or are underinsured.

Go to this link to learn more: Wisconsin drug repository

And in Ohio (also three cheers!):

Any person, including a drug manufacturer or any health care facility as defined in section 1337.11 of the Revised Code, may donate prescription drugs to the drug repository program. The drugs must be donated at a pharmacy, hospital, or nonprofit clinic that elects to participate in the drug repository program and meets criteria for participation in the program established in rules adopted by the state board of pharmacy under section 3715.873 of the Revised Code. ...

A pharmacy, hospital, or nonprofit clinic eligible to participate in the program shall dispense drugs donated under this section to individuals who are residents of this state and meet the eligibility standards established in rules adopted by the board under section 3715.873 of the Revised Code or to other government entities and nonprofit private entities to be dispensed to individuals who meet the eligibility standards. ...

The pharmacy, hospital, or nonprofit clinic may charge individuals receiving donated drugs a handling fee. ... Drugs donated to the repository may not be resold.

Read more: Ohio drug repository

Nebraska has had a program for cancer drugs since 2003 (Go Nebraska!)

Read more: Nebraska drug repository

Maryland: Maryland drug repository

Illinois: Illinois drug repository

Missouri's program isn't as good as some of the others, from the patient's point of view, because the only drugs that may be donated are drugs that were dispensed and used at nursing homes or hospitals:

For safety reasons, donated drugs must have been under the control of a healthcare facility or healthcare professional, and cannot have been in the possession of the individual owner.

Still, it's a start.

Read more: Missouri drug repository

Also, Georgia: Georgia drug repository

New York: New York drug repository

New York's law says the drugs must be in their original, sealed package, which means if I had a half bottle of zofran (worth more than $20 per pill), I couldn't donate it. I'm not sure how many of the other states have the same rule.

These states also have drug repositories in existence or in the works: Indiana, Hawaii, Minnesota, North Dakota, and Vermont.

Meanwhile, back here in Washington, my home state, no one seems to have heard of such a thing. We've got to get working on that one. Washington is home to 600,000 people without health insurance.

Support this blog:

@ Jeanne Sather 2008.

Medicare: Getting Closer to the Answers

I went off this morning, in the pouring rain, to see Leah deRoulet, MSW, LCSW, at the Swedish Cancer Institute. Leah is the best social worker I know, bar none, and I'm not the only one who thinks so.

Leah just won an award that puts her among the top dozen social workers in the country: She recently won the prestigious Lane Adams Quality of Life Award from the American Cancer Society. (Applause, please.)

Anyway, back to the purpose of my visit to see Leah: Of all the people I had e-mailed about sorting out Medicare, Leah was the only one who said, "It's not as hard as it looks."

So I figured seeing her was my next step.

I had all my questions written out, and I took along a list of all my prescription drugs.

This is what I learned:

* Tykerb should indeed by covered under Medicare Part B, rather than under Part D, which is the very poor prescription drug coverage plan.

It's on Part D that you fall into the doughnut hole and have to pay more than $2,000 out of pocket before Medicare starts paying for prescriptions again. And even then, there are copays and some drugs that are not covered.

* Supplemental insurance may be a problem.

Leah said that the private companies that cheerfully sell supplemental insurance to those 65 and older on Medicare do not want to insure people like me, who are on Medicare because we are disabled.

(This is sounding familiar.)

So, Leah suggested checking to see if WSHIP (the health insurance I have now) has a Medicare supplementary plan. She points out that Medicare Part B would be paying 80 percent of the cost of my cancer care, so the supplement only has to cover the other 20 percent.

She also thought that Basic Health (a state program for low-income people) might also have a supplementary plan for disabled people on Medicare.

This was all new information.

So next I'm going to call the state Insurance Commissioner's Office to see what they can tell me, and then I'll call WSHIP.

Ideally, I'd also be able to get some prescription drug coverage as part of the supplemental package--because I have six prescription drugs that I take regularly, not counting the Tykerb. Tykerb will be covered under Medicare Part B. (Part B will cost me $98/month.)

Whether or not I sign up for Part B depends on whether or not I can get supplemental insurance that provides reasonable coverage at a reasonable cost. Otherwise, I'm better off staying with WSHIP.

Even if I do get this all worked out, it's not likely to save me more than $200-$300 a month, but that's a lot when you're on Social Security Disability as I am.

So: Phone calls next.

Read about: Leah deRoulet

Read more:

Medicare Questions

Medicare Help

Tykerb and Medicare

Support this blog:

@ Jeanne Sather 2008.