Malignant: Pay Up

A Costly Disease

In case you didn’t know it, cancer costs a lot of money. A lot.

And if indeed you didn’t know this, it may be prima facie evidence you’ve been in a coma for the last seven or eight decades, which also costs a lot of money, I’d imagine.

Anyway, we got a letter the other day from some outfit called Medical Cost Management Corporation. Now neither The Loved One nor I know the first thing about any Medical Cost Management Corp. Which is why the meat of the letter was so hard to swallow. First, the letter thanked us for participating in its Outpatient Care Review Program.

We had no idea we were participating in any such thing.

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Okay, so we read on:

The proposed outpatient care is not medically necessary and appropriate; and therefore, not recommended.

Huh. So, uh, how much of my care? Part of it? All of it? Should I not be getting all so ramped up for chemoradiation therapy? Do I not have cancer (ohdeargodpleaseplease!)?

The letter goes on to say things like my health care is a decision to be made by me and my doctor and this ruling means medical bills won’t be paid (Some? All? Who knows?)

The Loved One looked about ready to have a nervous breakdown when she opened the letter Saturday night. I told her there was nothing we could do about it over the weekend so she should just put the letter down and let me take care of it Monday. It took a ton of persuasion to get her to follow my advice. (Remember, she’s suffering too.)

In my mind, of course, my plan was to ring this Medical Cost Management Corporation first thing Monday morning and demand to know:

  1. Who the fuck they are
  2. Why the fuck they’d sent us this letter at such an emotionally charged time
  3. And what the fuck they’re talking about, specifically

Oh, sweet blindness, I couldn’t wait to drop all those F-bombs on them! I’d envisioned myself the Gen. Curtis LeMay of F-bombing. This’d be especially gratifying if it turned out, as I suspected, that Medical Cost Management Corporation was some kind of scam outfit, trying to scare me into buying some kind of coverage from them. The bastards.

I counted the minutes down to this morning.

First thing I did was google the Corp. The first four listings that popped up were ads. Grrrr! I knew it! I scrolled down to the first non-ad link and clicked it. Lo and behold, what looked like the firm’s official page would not load.

The dirty bastards, I hissed.

So, I rang the company up. A receptionist answered and I told her, sweetly, I’d gotten a letter from her company and I had no idea who they are or what they want. It wouldn’t do for me to open my bomb bay doors over her — what if she was some kind of answering service? Gen. LeMay would have approved of my restraint. Conserve your ordinance for the most valuable target, he’d say.

The receptionist pushed me off to someone she said handled this kind of thing. Which I, naturally, took to mean a salesperson. Again, Grrrr. The person’s voice mail answered and I left another sweet inquiry and my phone number. Oh, I fantasized, am I gonna lay into that no good hyena!

While I waited for her callback, I dug a little deeper into the mystery. I checked my medical insurance card for my carrier’s number because I wanted them to know some dirty bastards were trying to muscle in on their business.

That’s when I discovered that, acc’d’g to the back of my card, Medical Cost Management Corp. is my insurer’s “Precertifier.” In other words. MCM is the outfit that makes sure the insurance co. isn’t being ripped off.

Oh.

Okay. Good thing I asked the receptionist and the woman I’d been pushed off on so sweetly. Really good thing.

So, I forced myself to read all the incredibly dense and arcane fine print in the letter. It turns out MCM had determined a certain drug that’s to be part of my chemotherapy regimen is “considered experimental and investigational.” Therefore, the company would suggest to my insurer to tell my doctor to take a hike once he submitted his bill for it.

Aw, fer goodness sakes! Is that all it is?

I dashed off a quick email to The Loved One telling her all is well, we’d probably just have to pay for some silly little drug. Who cares?

I closed the email with a little levity. “We’ve got nothing to worry about — unless it costs something like $100,000. Haha!”

Just as my finger was heading in a downward trajectory to hit the send button, a thought occurred to me: Jeez, how much does this damned drug cost?

So I did some more digging.

The drug is called pegfilgrastim, to be injected into my arm via an automatic little machine 24 hours after my chemotherapy infusion. I’d get a spritz of 6 milligrams of the stuff.

Pegfilgrastim is the official chemical name for the brand drug Neulasta. It’s a “recombinant human granulocyte colony-stimulating factor analog of the chemical filgrastim” used in portable infusion attachments. The International Union of Pure and Applied Chemistry specifies its molecular make-up must be N-(3-Hydroxypropyl) Methionylcolony-stimulating Factor (human), 1-Ether with . Alpha.-Methyl-.Omega.-Hydroxypoly(oxyethylene).

Oh my holy god, that’s gotta cost an arm and a leg for the name alone!

I dug further and found the cost of a single unit of the stuff is $9141.88. That single unit, apparently, is more than 6mg because my particular dosage should cost $5485.13.

That’s almost 5500 dollars for three separate shots. Or (sob) $16,500.

Is my life worth that much?

It may indeed be the cost of keeping me alive. Pegfilgrastim (or Neulasta) is designed to stimulate my immune system by kicking my white cell production into super-high gear. See, the platinum-based cancer fighting drug I’ll be guzzling beginning Friday (I just learned I’m on the schedule today) is an extreme immuno-suppressant. By the time I hit chemotherapy session number three, I’ll be vulnerable to every disease known to humans and maybe even a few not known, to boot. I may even fall victim to something only aardvarks normally catch.

I can imagine many, many things I would rather blow 16 grand on. A mint set of 1969 Topps baseball cards, for starters. My own professional pizza oven, too. An orange Harley Fat Boy. Lots of things. But I’ll have to pay it out, most likely, unless MCM changes its mind, to keep myself disease free for the next month and a half.

Man. Cancer sucks.

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I Wish

 

 

9 thoughts on “Malignant: Pay Up

  1. Susie Johnson says:

    My Mom had the same experience just a couple of weeks ago. She was able to get Neulasta from a Canadian pharmacy for MUCH less. She used planetdrugs.com. I know the name sounds hokey but she has acquired many of her prescriptions from them and saved thousands and they really have excellent customer service.

    Good Luck,
    Susie

  2. Susan Jones says:

    Mike, Let your chemo doc know. Perhaps he can make the case with your Insurance Co. Good luck!

  3. Gail says:

    Yes, let your doctor know and ask if there is any other drug available. ALSO….I don’t know if this ploy will work but I read ..that many times these precertifiers are actually doctors but people with little medical education. I have to go find the exact thing I read but basically it amounted to asking them to give you the names and credentials of the people doing this review who made the decision that the drug is “expermental” and medically unnecessary. The article I read said–many times the insurance companies were so embarrassed to reveal the credentials (or rather lack of) that they would cave and approve the treatment. I’ll look more for what I read about it.

  4. Gail says:

    Above I meant are NOT doctors.

  5. David Paglis says:

    I think when you doctor gets involved the recommendation will be rejected. If it isn’t, 16,500 is a lot of dough but your life is worth it.

  6. Moris says:

    It seems you are going through a lot of misery for a treatment that averages about 2-3% cure rate. Maybe it is higher now that we are in 2016, but surely you looked into it.

  7. Chris P. says:

    Ask your doctor to appeal this decision on your behalf. This scenario is not unusual. If need be, ask your oncologist’s office about patient assistance programs. The company that manufactures the HIV vaccine has a patient assistance program for patients who either lack insurance or whose insurance won’t cover the vaccine. I’m sure there’s a way to get your treatments done w/out bleeding your bank account dry.

    Document your calls to the insurance company…record the date, time & the name of the person you spoke with….Good that you’ve managed to keep your composure while on the phone w/ these folks. Good luck!

  8. Chris P. says:

    One more thing:While you’re on chemotherapy, wash your hands frequently.

  9. Ron Eid says:

    You might also want to ask about the RAP clause, as it pertains to Radiologists, Anesthesiologists, and Pathologists, because I’ve just been told by my insurance provider that Bloomington anesthesiologists do not contract with insurance companies, which means the entire bill could fall on the patient. It is also known at the Radiologists, Anesthesiologists, Pathologists, and Emergency-Providers clause (I’m not kidding), which of course could be rightfully be called the RAPE-P clause.

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