Healthcare costs and insurance woes and victories

Those of you who have read this blog from the beginning may recall my posts about how inexpensive healthcare is in Germany compared to the US. I now have additional proof. I've been receiving "explanation of benefits" statements from Aetna detailing the cost of my hospital stays and other healthcare services since the end of July. Close your eyes and guess how much these amount to. Higher. No, higher. Still higher.

Well over $200,000. Of that, I have paid maybe $100 plus some $20-30 co-pays for doctor's visits. Add to that my cancer and blood thinner medications, which would cost about $16,000 per month without insurance. I have no idea what people in my situation do if they are uninsured or under-insured.

My recent interaction with one of my German doctors illustrates another stark difference. Before leaving Germany, I had asked my doctor what to do if I received bills from the LungenClinic after we had moved and closed our Deutsche Bank account (all bills in Germany are typically paid through bank transfer, not credit card). I was shocked when he said he would pay it and I could send him the money via PayPal, etc. He explained that he had lived in the US and understood that financial transactions can be a pain. Sure enough, I recently received several small bills. He was still willing to do the transaction, so I sent him the money and he paid the bills from his bank account. We'll do the same for another bill I just received. I am blown away that he's willing to do this. I cannot imagine this happening in the US.

Dealing with insurance has also contributed to my stress. In Germany, we paid for my first Tagrisso prescription out-of-pocket ($6500), assuming we would be reimbursed since this drug is covered by CVS/Caremark. They refused to reimburse it because it wasn't pre-authorized, but my current oncologist wasn't allowed to do a retroactive pre-authorization because she didn't write the prescription. There seemed to be no solution. I sent an email to Penn State Benefits asking someone to intervene, but I never heard back. Within a week, I received a call from CVS/Caremark that they are going to reimburse us! I can only assume that some unknown angel in Benefits advocated for me or that someone at CVS sorted it out. Thank you, whoever you are!

I am tearing my hair out because of all the roadblocks Aetna is putting up to approving a portable oxygen concentrator. This would make my life infinitely easier. I cannot travel more than a few hours away or anywhere overnight because I would have to load up the car with a bazillion oxygen tanks. One tank lasts only a few hours. Plane travel is out of the question. For daily life outside of my house, it would be far more convenient to carry a little backpack instead of lugging a heavy oxygen tank, wondering if I have enough oxygen for X hours, etc. I recently saw an older woman carrying a portable  concentrator. I was instantly envious. I have no idea why the countless doctors/nurses/case managers I saw at two hospitals in August never mentioned that I could get one. I only found out about it from my pulmonologist in early September. 

It can take 6-8 weeks to get a portable concentrator even after it's approved by insurance. Since my pulmonologist sent the prescription/order on Sept. 9, Aetna has been requesting changes and additional information. First, they said COVID wasn't an adequate reason, so the prescription had to be changed to lung cancer and pulmonary embolisms. Then Aetna said the pulmonologist had to send tests results and doctor's notes. When I talked with the oxygen supply company yesterday, they said the latest hold-up was that the script said "portable oxygen concentrator." According to Aetna, it's supposed to read "home oxygen concentrator - with portability." (This seemed like something straight out of Monty Python: People's Front of Judea vs. Judean People's Front). But then I got a call from the pulmonology office saying that Aetna was mistaken: they thought I needed another home oxygen set-up. So now, 3 weeks later, they finally realized that I need a portable concentrator--just like my doctor said from the get-to! Unbelievable. Clearly someone at Aetna was promoted above their level of competence. 

I am frustrated that we can't make any plans to travel to see family in MI or MN, for Thanksgiving or otherwise, until I know if/when I will get a portable concentrator. A quotation from Suleika Jaouad's book, Between Two Kingdoms, is appropriate here: "To learn to swim in the ocean of not-knowing--this is my constant work." More on this book in my next post. 

Postscript: I celebrated too soon. We just got another claim rejection from CVS for the Tagrisso prescription. This time it was because the prescription was for 30 days and they only approve 15 days. So now my oncologist needs to submit more paperwork to request an over-ride of the 15-day supply.