Liability

"Hello?  You left a message for me to call you back? This is the minivan philosopher." I offered to the woman on the other line.

"So we wanted you to be aware of your liability for the CT scan your oncologist has ordered for you." said the woman on the phone.

"Yes?" I replied, holding my breath.

"Okay so your liability is $2,345.00" she almost whispered as if embarrassed to say that figure to me.

"Oh??  Is that the final cost after insurance?" I gulped.

"That's your estimated liability." she replied.

"Well I don't have it.  I guess you will have to bill me." I clipped.

"I will make a note of that." she replied.

"Thank you. Good bye."  I said.

"Goodbye." she replied.

Click.

Yep.  That's my post-cancer diagnosis, ongoing monitoring life.  What am I supposed to do?  I've been having butterfly sensations floating around in my abdomen for a few weeks now.  I told my oncologist about it at my follow up and he said let's do a CT to make sure nothing is going on.  I agreed because I want to know if there is anything I need to worry about.  So I make the decision to go further into debt for peace of mind?  Or do I cancel the scan because I don't have the money to pay my estimated liability and risk that there is something significant going on?  And maybe die of cancer?

The ongoing financial stresses of having a cancer diagnosis and its subsequent treatment (chemo, surgery, medicines, doctor visits, blood tests etc) dishes out as much suffering as all those words contained in the parentheses.  In fact, it's worse because the institutions don't give a rat's *ss about who you are, you are simply an account receivable.

I find myself feeling angry at the helplessness again.  Since my cancer diagnosis in July 2013, I have shouldered the entire financial cost myself.  I didn't start any gofundme campaign.  I didn't ask anyone to help pay a bill.  Not any friends or family.  I didn't get any either.  I did receive help in the form of rides, some meals for my boys and a few giftcards every now and then.  But nothing to help me chip away at the $10,000 or so in bills for which I was "liable'.  And now I've got another $2300 to add to it.  Yippee! Wonderful!  Please sir, can I have another?

I don't know what to do.  I am too young for Medicare.  I have a full-time, good-paying job with insurance so I can't have the state pay for my medical care.  So I'm basically fucked financially for the next five years while I'm monitored by my doctors.

Sigh. 

Cancer... the gift that keeps on giving even when you've said "enough!!"

30 days hath September...

And a busy thirty days it has been!
Lots of tests, procedures, doctor visits  and more.  Mostly brought about because my insurance resets on October 1 and I have to climb that steep deductible hill all over again.  So instead I pushed to get as much done before October 1 as possible all with good results, too!  My PET scan came back all clear again - "grossly unremarkable" said the doctor.  Then my blood tests came back all normal.  So my port was successfully removed on the 22nd. Saying I am so happy to have it out is an understatement.  (I am thinking that perhaps when I pass the five year mark, I will get a tattoo over the scar.)  And then finally today I had my one year follow up colonoscopy and it too came back clear!  They want to see me again in three years!
The monitoring/maintenance plan will consist of blood work every three months for four years and a CT scan every six months for the next two years.

I have also cut my hair short with great results.  My post chemo hair is so wavy.  I used to have straight straight (did I mention straight?) hair.  So having all this wave is quite interesting.  Friday night I was told I looked like Katie Couric (which I have heard before) and also Princess Diana which was a new one for me.  Then this morning's nurse also said Princess Diana.  I am very much flattered.

It seems I've been struck by Paco Rabanne's Million again at Café Eau but this time he's an Italian pilot.  Stay tuned, the philosopher's phase 2 could be really really interesting.

Numb3rs

Numbers.
365 days.
1 surgery
2 colonoscopies
2 MRIs
2 CT scans
3 PET scans
5 ER visits
12 chemo treatments
25 pounds gone (10 jumped right back on)
150 hot flashes
-20 wind chill
1 weekly support session
47 Caringbridge entries
5 pairs of gloves
3 hats
2 wool socks
1 chemo blanket
1 chemo fanny pack (burned)
1 grey hoodie.
$252,000+ billed to insurance companies
And a million prayers said!
All this in the one year since I received my colon cancer diagnosis.  One more number that really takes the cake – two weeks ago at my latest blood test, my tumor marker (CEA level) test came back…  <=5 of whatever units they measure is considered normal or good…  my number…. 1.4!!!
I feel pretty amazing.  Hands and feet getting better every day (love my B vitamins!), muscles stronger, taste buds back (hence the 10 pounds), hair growing (I’ve got bangs!  I haven’t had bangs since 4th grade!).  There are days when the memory of my cancer journey seems like a dream that someone else lived.  Then there are days when I remember every gut-wrenching side effect and am thankful they are, simply, a memory now.  (Especially those clear the room chemo farts!!!)
Thanks for being along for the ride, for your words of support and encouragement, for the meals, the rides, the “sure, we can talk about this cancer thing some more” patience and for the love.  It’s what makes everything bearable. 
Love you.  Thank you. 

The wonderful world of a cancer patient's medical bills

Dear readers:
Below is a copy of the letter I sent to SLUCare... we'll see if I get any response.
******

2/12/14

An Open Letter to SLUCare CEO, Gary Van House:

Dear Mr. House:

You don’t know me but I am currently a cancer patient receiving chemotherapy treatment for stage 3A colon cancer at St. Louis University Cancer Center.   Why does this matter to you , you ask,  and why am I writing you?

I am writing because your company, outside of its doctors and nurses, seems more interested in me as a profit center than as a human being working to survive my cancer diagnosis and treatment.  No one wakes up deciding to get cancer so they can ‘enjoy’ undergoing chemotherapy, radiation, and/or surgery.  No one decides to get cancer because they want to have thousands of dollars of additional medical bills to pay.  No one chooses to experience any of these things.  But for those of us ‘lucky people’ who get the cancer diagnosis and are told we need surgery and after that chemotherapy for six months and that none of it is a guarantee that we will be cured, we get put on the cancer/chemotherapy conveyor belt and our lives are never the same.

There are physical, emotional and financial stresses of going through treatment and living with cancer. 

Do you know what it’s like to have your hands and feet hurt constantly with prickly, stabbing pain?  That it’s something you just have to endure because it’s one of the side effects of the most expensive chemo drug ($10K a treatment) being pumped into your body (which only promises a 5% increase in the likelihood of a cure)?  Do you know what it’s like to not be able to swallow without feeling like someone has scraped your mouth with broken pieces of glass? Do you know what it’s like to have handfuls of your hair fall out daily? Do you know what it’s like to worry that every new ache or pain could be a sign that the cancer is back or growing or not reacting to treatment?  Do you know what it’s like to worry how you are going to pay for all the bills in your quest to stay alive? Do you know what it’s like to end up in the ER five times in six months because your immune system is compromised? Do you know what it’s like to only be able to muster up the energy to go from bed to couch to back to bed for days on end?  Do you know what it’s like to tell your children you have cancer?  Do you know what it’s like to keep working through all this because you have to keep your income and insurance?  Do you know what it’s like to do all this as a single parent on a single income?

I didn’t think so.

Because if you had, you certainly wouldn’t have your billing department call me on a Saturday morning to complain that I have let my bill get out of hand and that I wasn’t paying enough money every month.  You wouldn’t have your billing department ignore the fact that I was paying twice as much as the agreed budgeted amount every month and that I had never missed a payment.  Even after I told your billing representative that I didn’t set the prices of the chemotherapy drugs, that I was simply following my oncologist’s directives for beating this wretched disease and that I didn’t have any control over what was being billed, she replied that my bill was simply too much anymore.  I asked the representative if she wanted me to survive my cancer treatment, she said that, of course, she did. 

Do you want me to beat this cancer?  It seems not.

Yesterday, two weeks after my latest SLUCare bill (and one week after my last payment) which includes the statement about the agreed budgeted amount, I received a collection notice from Consumer Collection Management in Maryland Heights telling me that my account has been listed with their office for collection.  Yes, that is correct, your company listed me as a bad debt.

Stress.  Stress negates any positive benefit that one can get from chemotherapy.  Your company’s aggressive tactics have only added more stress to an already over-the-top-maxed-out stressful situation.  Your practices infer to me that you don’t have a lot of confidence that those receiving cancer treatment from your company will survive long enough to pay you, so you better get those dollars now, today, pronto.  Your company’s policies treat me as if I have been neglectful towards my medical bill with you, when in fact, I haven’t.

I have paid the agreed budgeted amount every two weeks.  Yes the bill increased, I couldn’t control that.  Insurance calendar years and resetting high deductibles and out of pocket amounts are not things I can control.  But your company’s unwarranted punitive actions are heartless, uncaring and tell me that greed is SLUCare’s motivation not patient survival and health. 

As your practices and policies currently stand, I cannot and will not in good conscience recommend to anyone facing a cancer diagnosis to come to SLU Cancer Center.  And it’s not because the care has been inadequate but because compassion, understanding, flexibility and a sense of humanity is not present beyond the patient care team.  It appears, if one receives treatment from your organization, the only guarantee is they will be harassed by your billing department.

As the Chief Executive Officer, don’t you think you can do better, be better? Don't you want to?

I have included my contact information should you have a desire to talk further with me.

And I hope, sir, you never have to face cancer.

Sincerely,

The Philosopher