9/2/20: I Guess I Don't Need Referrals Anymore?

According to my meticulously kept records, the referral for my medical oncologist expires today. I called my PCP's referral line to get a new referral for my new doctor. Surprisingly, they said a referral isn't needed because the specialist is in the same hospital network as my PCP. 

I asked if this is a new policy, and they said it's been in effect since at least February. I actually noticed that the referral I requested for my cardio-oncologist in August was not showing up in the online patient portal; they confirmed that they have a record of the request, and that a referral wasn't needed because the cardiologist is in the same hospital network. My online patient portal does show a new referral for my breast surgeon in June, and for my genetic counselor in July; they are both in the same hospital network, too, so now I don't understand why those went through, but I guess it doesn't matter, as long as my insurance covers the appointments.

3/20/20: I Checked My Insurance Claims Online

As usual, these are the "Claim Total" amounts. We've already met our deductible for our coverage year, so the "You Pay" amounts were all $0.

2/7/20: Maintenance Herceptin #3 (Including Blood Work, Physical Therapy #18): $16,472.32
2/10/20: Medical Oncologist Appointment: $260
2/10/20: Medical Oncologist Hospital: $84
2/21/20: Lupron (Including Physical Therapy #19): $978.16
2/28/20: Maintenance Herceptin #4 (Including Blood Work): $15,840.75
3/4/20: Medical Oncologist Appointment: $260
3/4/20: Medical Oncologist Hospital: $147
3/9/20: Bone Density Test Hospital: $674
3/9/20: Bone Density Test Radiologist: $44

Total cost to date: $241,393.11
With insurance, cost to me: $4,254.63

3/17/20: The Hospital Called Me to Re-Schedule My Echocardiogram

The scheduler asked if I would mind pushing my echocardiogram appointment 2 weeks out. I said that's totally fine, but I also asked if it would make sense to keep it sooner rather than later, since the coronavirus situation is only expected to get worse in the next couple weeks. She said, well, that's not actually an option, they are simply re-scheduling everyone. Sounds like they are in full preparedness mode.

My letter of authorization from the insurance company says I need to schedule the procedure within a one-month time frame. The scheduler assured me that it's easy for them to re-request authorization if they need to push my appointment out past the existing window.  

2/10/20: I Checked My Insurance Claims Online

As usual, these are the "Claim Total" amounts. We've already met our deductible for our coverage year, so the "You Pay" amounts were all $0.

12/20/19: Medical Oncologist Appointment: $258
1/10/20: Physical Therapy Appointment #14: $393
1/17/20: Maintenance Herceptin #2 (Including Blood Work, Medical Oncologist Hospital, Physical Therapy Appointment #15): $15,858.27
1/17/20: Medical Oncologist Appointment: $260
1/24/20: Lupron (Including Physical Therapy Appointment #16): $964.16
1/31/20: Physical Therapy Appointment #17: $393

Total cost to date: $206,632.88
With insurance, cost to me: $4,254.63

2/10/20: I Picked Up Prescriptions

My medical oncologist sent 3 prescriptions to the pharmacy. She said the vitamin D supplement was available over-the-counter, but she provided the prescription in case the pharmacy could fill it for cheaper. The over-the-counter version turned out to be cheaper, plus it was on sale, buy one get one free.

Furosemide (to reduce swelling):
Retail price was $11.99, our prescription co-pay was $4.41.

Klor-Con (potassium chloride):
Retail price was $19.09, our prescription co-pay was $10.00.

Vitamin D3: $10.79

Total cost to date: $188,506.45
With insurance, cost to me: $4,254.63

1/16/20: I Checked My Insurance Claims Online

Since we've already met our deductible, the "You Pay" amounts for these claims were all $0. The numbers listed below are the "Claim Total" amounts.

11/22/19: Medical Oncologist Appointment: $258.00
12/5/19: Medical Oncologist Appointment: $258.00
12/5/19: Medical Oncologist Hospital: $84.00
12/6/19: Chemotherapy Cycle #10 (Including Blood Work, Physical Therapy Appointment #9): $7,473.23
12/11/19: Echocardiogram Cardiologist: $240.00
12/11/19: Echocardiogram Hospital: $1,133.00

12/13/19: Chemotherapy Cycle #11 (Including Blood Work, Physical Therapy Appointment #10): $7,535.23

12/20/19: Chemotherapy Cycle #12 (Including Blood Work, Medical Oncologist Hospital, Physical Therapy Appointment #11): $7,640.23
12/26/19: Maintenance Herceptin #1 (Including Blood Work, Lupron, Physical Therapy Appointment #12): $16,323.62
1/2/20: Physical Therapy Appointment #13: $393.00

Total cost to date: $186,964.59

With insurance, cost to me: $4,229.43

12/8/19: I Checked My Insurance Claims Online

Since we've already met our deductible, the "You Pay" amounts for these claims were all $0. The numbers listed below are the "Claim Total" amounts.

10/3/19: Medical Oncologist Appointment: $363.00

11/8/19: Chemotherapy Cycle #6 (Including Blood Work, Medical Oncologist Appointment, Physical Therapy Appointment #7): $7,264.25

11/15/19: Chemotherapy Cycle #7 (Including Blood Work, Physical Therapy Appointment #8): $7,532.14

11/22/19: Chemotherapy Cycle #8 (Including Blood Work, Medical Oncologist Hospital): $7,396.14
11/29/19: Chemotherapy Cycle #9 (Including Blood Work, Lupron): $7,847.61

Total cost to date: $145,626.28

With insurance, cost to me: $4,229.43

11/25/19: Insurance Letter Confirming Approval for Echocardiogram

Last Wednesday, when I made my appointment for another echocardiogram, I was given a range of allowable dates. Today I received the letter from my insurance company giving authorization for the echocardiogram within those dates. 

The echo is to monitor my heart because one of the possible side effects of Herceptin is weakening of the heart's pumping action.

11/15/19: Chemo Cycle #7 of 12 + Social Worker Visit + (12 Weeks Post-DMX) Physical Therapy Appointment #8

Ken dropped me off today so he could teach a double lab in the middle of the day.

I had a 9:45 appointment to get my port accessed and blood drawn. The port nurse noticed that my skin was irritated again, and I told her I've been alternating between bandaids and gauze with medical tape to cover the incision with antibiotic ointment. She agreed that the incision looks better. She said she sees every port that goes through the Cancer Center, and she's noticed an increase in the number of incisions that don't heal well. She's been keeping track of all new ports starting from a couple months ago, and I'm one of her data points! A whopping 55% of new ports have had issues. She thinks it may be related to stitches poking through and not dissolving properly. Anyway, she's reporting her data to the appropriate people at the hospital, and she says they are looking into it. It feels pretty great to know there are nurses like her who are actively trying to improve patient care!

We chatted a bit about my hair loss, too. She said that years ago, the Cancer Center used to provide their patients with cold caps, to help prevent hair loss. But they stopped at some point because of a concern that the cold that prevents hair loss also prevents the chemotherapy drug from circulating in the scalp, which may actually increase the likelihood of stray cancer cells surviving in the scalp. So one perspective is to look at hair loss as evidence that at least the chemotherapy is doing it's job; if it's killing fast-growing hair follicles, hopefully it's also killing cancer cells lurking in the scalp.

With my port accessed, I went upstairs to the infusion room, and the medical assistant took my vitals. She showed me to my bay around 10:15, and she set me up with a pillow and a warmed blanket, as usual. I ordered my lunch, plus one for Ken since he'd be joining me later.

My infusion nurse came in to ask about my weekly side effects, and suddenly the tears just started falling. She sat down and was very comforting. She reassured me that losing my hair is a kind of loss, and so there is a grieving process. I heard the same advice about losing my breasts when I had my surgery. It's just a lot to deal with, especially at the same time.

She asked if I had considered a wig, and I said I'm not really up for that option. She suggested again that I could cut my hair shorter, it might make the thinning less visible. I don't know, I'm just not feeling a hair cut, either. Basically, if I want to do something about the hair thinning, the options come down to getting a short hair cut, wearing a wig, or wearing a headcover like a scarf or hat; just none of them feel like "me". So the "best" option feels more like the least uncomfortable, least drastic option. My nurse encouraged me to get some hats, like a bunch of beanie-style hats in all different colors, and just wear them all the time so I get used to wearing them myself. Without my even mentioning it, she touched upon my hesitation to wear a hat to dinner last night (I didn't), and also suggested getting a more formed hat for when a winter beanie or baseball cap wouldn't feel appropriate, like when going out to a nice restaurant.

Anyway. I took my pre-meds around 10:30. My nurse said we would have to wait for my doctor to put in new orders, and then wait for the pharmacy to prepare the drugs. In the meantime, she got my IV set up, and took a look at the port incision through the clear dressing. She said it does look better, and to keep using the antibiotic ointment, since it still looks like it has some more healing to do.

Around 11:00 the social worker stopped by for a brief but helpful visit. (She just happened to see me while passing through the infusion room, but had another appointment coming up.) She sat down and asked me how my week went, and again the tears just came. She gave me some much needed comfort, saying that even though side effects can be predicted, that doesn't make them any easier when they happen. She also pointed out that hair loss in particular is so visible and drastic that it makes the whole idea of being in cancer treatment feel more real. I think that's especially true for me, because with other side effects being "mild" and not visible, and not experiencing any nausea at all (knock on wood), I kept thinking I was getting off easy, which makes this dramatic manifestation of cancer treatment feel all that more distressing.

My physical therapist came in at 11:15. She worked on my cording, and then declared it resolved! She said she couldn't feel it anymore. She also took measurements of my range of motion, so now I have objective data that my range has improved to be within the low end of being fully functional. Yay!

She took a peek at my incision scars, and said they are healing really well. I've been massaging them as instructed sort of intermittently; it just feels weird when I touch them. I'm supposed to keep up with the massaging as much as I feel comfortable, and also continue to stretch, since I still feel a lot of tightness, a little soreness, and my range of motion has room for improvement. We decided to set up a follow-up appointment in December to see how things are going, and we'll have that appointment in her regular exam room so there is more privacy for her to work on my scars.

I started the Herceptin around 11:30, during the physical therapy visit, and then started Taxol around 12:00.

Once finished, the nurse gave me my blood work report. My Im Gran (Immature Granulyte) is still a little high, a bit higher than last time. For the first time, my Monos (Monocyte) number is out of range on the low side. I kind of wonder if the healing action going on in my port incision is affecting these numbers. Also for the first time, one of my liver numbers, TotProt (Total Protein count of albumin and globulin, which are both within range), is very slightly out of range on the low side. I guess all this is normal during chemotherapy, so I'm not worried about anything, just find it an interesting exercise to track my blood work.

My nurse also gave me a note with instructions to call the cardiology department for an echocardiogram appointment. I need an echocardiogram every 3 months, I think because Herceptin can weaken the heart. (I called and they said they need to get insurance pre-authorization first, so they will call me back once they have it.)

Ken hadn't returned yet, so at 1:15, with his lunch in hand, I went downstairs to wait in the larger waiting area downstairs. Not counting the time I had to wait for Ken, this appointment was about 3 1/2 hours.

11/9/19: I Picked Up a Prescription + I Checked My Insurance Claims Online

Since we've already met our deductible, the "You Pay" amounts for these claims were all $0. The numbers listed below are the "Claim Total" amounts.

10/8/19: OB/GYN Appointment: $364.00

10/18/19: Chemotherapy Cycle #3 (Including Blood Work, Medical Oncologist Appointment, Flu Shot, Physical Therapy Appointment #4): $9,405.31

10/25/19: Chemotherapy Cycle #4 (Including Blood Work, Physical Therapy Appointment #5): $7,034.71

11/1/19: Chemotherapy Cycle #5 (Including Blood Work, Lupron, Physical Therapy Appointment #6): $7,648.48

I got a refill for 3 months of loratadine, which was not covered by insurance, so that was an out-of-pocket expense.

11/8/19: Loratadine Prescription (3-Month Supply): $27.20

Total cost to date: $115,223.14

With insurance, cost to me: $4,229.43

10/18/19: I Picked Up a Prescription + I Checked My Insurance Claims Online

Interestingly, the pharmacy did fill my prescription for loratadine (which is generic Claritin), but insurance doesn't cover it, presumably because it's available over the counter. But, the full price of the generic from the pharmacy is still cheaper than the cost of the same number of tablets of Claritin ($25.99 at CVS) or the CVS brand loratadine ($20.49).

10/11/19: Chemotherapy Cycle #2 (Including Blood Work): $6,999.06 (Covered by Insurance)
10/18/19: Loratadine Prescription: $9.07 (Out-of-Pocket Expense)

Total cost to date: $90,743.44
With insurance, cost to me: $4,202.23

10/12/19: I Checked My Insurance Claims Online

With payment of the last bill, I met my insurance deductible, so all my remaining medical claims for the coverage year should be paid in full by my insurance.

I don't think the insurance company sends me any statements when I don't have anything to pay, so I logged into my online account to see what has been charged.

Like I mentioned before, I don't fully understand everything that's posted in my online account, especially in the claim detail pages. But the "Recent Activity" summary page lists two numbers, a "Claim Total" amount and a "You Pay" amount. I'm using the "Claim Total" in my "Total cost to date" tally. The "You Pay" amount for all these claims is $0.

8/23/19: Surgery Breast Surgeon: $9,754.00
8/23/19: Surgery Pathologist: $1,553.00
8/23/19: Surgery Hospital (Incuding Pharmacy, Anesthesiology, Radiology, Pathology): $18,716.15
9/17/19: Oncotype DX Testing: $4,620.00
9/18/19: Physical Therapy Appointment #1: $492.00
9/19/19: Medical Oncologist Appointment: $552.00
9/19/19: Medical Oncologist Hospital (Including Blood Draw/Lab Work and Appointment): $842.00
9/23/19: Physical Therapy Appointment #2: $250.00
9/24/19: Hospital (Blood Draw/Lab Work): $82.00
9/25/19: Port Placement Hospital: $5,789.98
9/25/19: Port Placement Surgeon: $1,162.00
9/26/19: Port Check Appointment (Bruise): $161.00
9/26/19: Echocardiogram Hospital: $1,133.00
9/26/19: Echocardiogram Cardiologist: $240.00
10/2/19: Physical Therapy Appointment #3: $375.00
10/3/19: Hospital (Including Blood Draw/Lab Work): $737.00
10/4/19: Chemotherapy Cycle #1 (Including Lupron): $11,601.92

Sub-total: $58,061.05

Total cost to date: $83,735.31
With insurance, cost to me: $4,193.16

10/12/19: I Got Billed Again For Surgery

8/23/19: Surgery Anesthesiologist: $3,540.00
With insurance, I paid: $2,165.03

Total cost to date: $25,674.26
With insurance, cost to me: $4,193.16

10/4/19: I Got Billed Again for Surgery

8/23/19: Surgery Radiologist (Radioactive Dye Injections): $137.00
With insurance, I paid: $103.64

Total cost to date: $22,134.26
With insurance, cost to me: $2,028.13

10/3/19: Insurance Letters Confirming Approval for Medications

Wow, I did not know that insurance pre-authorization was needed for Lupron and Herceptin. I got a letter for each today, authorizing the use of these drugs for a 1-year period.

I guess the doctor's office will need to renew authorization for Lupron every year? Interesting. 

10/3/19: I Picked Up the Anti-Nausea Prescription

The ondansetron hydrochloride's retail price is $147.99, but my prescription co-pay was $15.16.

Total cost to date: $21,997.26
With insurance, cost to me: $1,924.49

9/25/19: Insurance Letter Confirming Approval for Echocardiogram

Apparently, tomorrow's echocardiogram requires pre-authorization. I received a letter stating that my request had been approved.

Amusingly, this is the first insurance approval notification that arrived prior to the actual procedure/test.

9/24/19: I Picked Up Chemo-Related Prescriptions

Lorazepam (use for sedation or anti-nausea):
Retail price is $17.29, our prescription co-pay was $1.30.

Prochlorperazine (use for anti-nausea):
Retail price is $22.99, our prescription co-pay was $6.60.

Lidocaine-prilocaine cream (use to numb port area):
Retail price is $49.99, our prescription co-pay was $10.00.

Total cost to date: $21,849.27
With insurance, cost to me: $1,909.33

9/23/19: I Got Billed for Surgery

My online account for my health insurance shows a LOT of activity, but I figure I won't log any costs until I actually get billed.

I honestly don't understand some of the online health insurance statements. There are claim summaries and claim details, and sometimes none of the numbers match up in any way. I can't make much sense of it.

The printed statements we get in the mail are more comprehensible. Mostly I just look at the "Provider Charge" and "Your Responsibility" amounts.

The amount we get billed should match the "Your Responsibility" amount on the insurance statement. Before we pay, I cross-reference those values to make sure they match up.

8/23/19: Surgery Hospital (Pathology Lab?): $3,643.00
With insurance, I paid: $995.76

Total cost to date: $21,759.00
With insurance, cost to me: $1,891.43

9/19/19 - 9/20/19: Insurance Letters Denying and then Approving Oncotype Testing

I didn't even realize that Oncotype DX testing required pre-authorization from my insurance company. I learned from the MRI and genetic testing that all the pre-authorization business is between the doctor's office and the insurance company; there's nothing for me to do.

I know my cancer was tested because we discussed the results with my medical oncologist. On the same day as that appointment, I got a letter saying the Oncotype testing was denied by my insurance. I didn't worry about it too much, because the testing already happened, though I wondered if I'd get hit with a giant bill later.

Today I got a letter approving the testing.

Can't say I understand how the insurance industry works.