Friday, June 13, 2008


I'm writing this on my new computer, and it's running Windows Vista . . . which I have to say I haven't heard a lot of great things about except this joke: "Intel Giveth; Microsoft Taketh Away." The new computer has a fancy new Intel chip and seems to be quite fast . . . but it hasn't been exactly working consistently yet, so we'll see how this post goes . . . during my first attempt, the computer simply shut down and restarted on its own. Hmmm.

It's impossible to write a blog about medical issues without touching on medical insurance, probably many, many times over the summer. I haven't gotten to it before now because right in the middle of this first month of treatments Ian started a new job and our insurance changed, and I wanted to at least have it somewhat settled before trying to get any of my thoughts about it down on "paper". Well, it's somewhat settled, so here goes.

First of all, the insurance that Ian carried as a graduate student did a fine job of almost covering me for my past cancer treatments. We had a $100,000 yearly limit per person, and I only went over that for about five years. During those five years I also carried the Washington State High Risk Pool private insurance, which isn't real insurance per se but counts as it, because for most of those years I think my infusions alone cost something like $130,000 per year. The only issue with using these two insurances concurrently was that each one preferred to be secondary. The Washington State Health Insurance Pool won for secondary, but the University of Washington Medical Center kept forgetting that, so about every three months I'd have to call in and ask them to switch the order of the insurances in their files. I would've preferred to be able to leave it alone, but, well, sometimes you just have to do tedious things. Anyway, out of pocket expenses were low, and ultimately the system worked very well for us.

In January of this year, I cancelled Washington State Health Insurance Pool because it started costing almost $400/month for the premiums. Fortunately, with Ian's new job, I think this will work out to our benefit. Anyway, with the new job came a couple options: 1. Group Health, which I used growing up and which my mother, a retired school teacher, still uses—a fine option, and one of the first HMO-type organizations (from what I understand), and pretty well respected in the area; or 2. Uniform Health, the public employee's typical choice. We had originally considered choosing Group Health—I thought that if I was going to be doing cancer stuff, I'd maybe like a change of scene—new nurses, new docs, new infusion room—but then, when the pesky brain mets appeared, it suddenly became clear that having access to the UW, and Dr. Jason, was MUCH MORE IMPORTANT than any sort of scene shift. So Uniform it is, and, although I've heard accessing financial support for occasional treatments—certain brain surgeries, gamma knife radiation, etc—is sometimes a bit like pulling teeth without even Nitrous, ultimately Uniform pays out a lot of cash.

There are hoops, however. Prescription coverage, for one. The shots that I'm giving myself? Those ones where the first six cost $1700 (note: still have to submit that to the old insurance for reimbursement)? Well, we needed to pick up our new prescription for those last Thursday when I was having my second chemo. So we gave our new insurance info and were told no problem, we could pick up the shots at the back window of the pharmacy until 10pm. Except that, at the end of my long day of infusion and being moved about, we couldn't actually pick up my shots—which I needed to start injecting the next day—because of some issue with the insurance not wanting to pay for them. Ian (the sweetheart) spent probably an hour on the phone the next morning with various people trying to work things out, and found out that I couldn't just pick up the shots at the local pharmacy because they fell under a unique category of "special injectible" with our new company . . . and therefore had to be mail-ordered. Hello?

Fortunately, it is possible, if you don't want to self-inject, to go into the clinic every day and have a nurse do the shot, which is then included under "infusions" and therefore covered by the insurance in the same way that infusions are. Of course, then you have to go into the clinic every day. And every time you go into the clinic, you check in, you wait, you get your room, you wait, you have your vitals checked, you wait while the drug is ordered, then you get your injection (which, in and of itself, takes about 1 minute). So it's at least a 45-minute round trip, and we're lucky and live only 10 minutes away. Talk about tedious. And, undoubtedly, much more expensive for the insurance company.

But we were able to expedite our order (again, thank you SO MUCH Ian), and it arrived on Wednesday afternoon, in time for me to self-inject my last dose of the week. The only problem with the order was that they sent crap syringes. First of all, they're not the smallest needle available, and I'm sorry, but I am not willing to hurt myself every day—I want the insulin syringes. Second, the needle part isn't even screwed on to the syringe part, so when you pull the cap off the needle, you pull the needle off the syringe. It seems somehow both more dangerous and more dirty. So back at the SCCA yesterday for infusion 3, we simply purchased—with our own money for a very good cause—a box of good syringes that will cover me for most of the summer. I do have about 50 bad syringes if anyone wants them (actually, I probably can't legally offer that).

Health insurance websites are also probably among the least user-friendly, least intuitive sites out there—just trying to log on to one (and so far I think we each have something like four different log ons for various elements of this particular organization) makes my brain float out the window, and trying to navigate around, once on the site, is like being way too drunk. I keep thinking I'm a smart person, and how can less smart people function at all? I'm sure it's part of why insurance is such big business—people can't function, and pay probably millions of dollars a year for treatments that are supposed to be covered. Also, I can get angry almost instantly because I feel like sick people should have the benefit of ease in this case, and they really don't.

However, we do have insurance, and it does cover amazing treatments in this country. Herceptin, for example, which I was on for five years and which Dr. Specht suggested I might be on for the rest of my life, is something that is available in New Zealand for a maximum of six weeks. Yes, that's a big difference. And, in fact, enough to make us really glad to be here.

Although we are really, really glad to be here for so many other reasons as well.

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