Thursday, August 30, 2007

I had a visit today with my Oncologist and my labs show whatever they are supposed to show to clear me for round three of chemo on Tuesday. I had to go to an off site lab yesterday for my blood draw because apparently Georgetown Hospital lab has given me the boot. They don't like how Aetna pays, or more to the point, how Aetna doesn't pay for my labwork so they asked me to go elsewhere.

I meant to call Aetna to harass them about why they are paying so little for my labs. When I look at the claim online it looks fishy. There are three numbers to look at on each claim. Column one is the amount the provider submitted, the second column is the Aetna agreed pricing which is usually a fraction of what the provider asked for and the third column is the amount Aetna paid. Now on most claims, columns two and three match. If Aetna agreed pricing is $100 they cut a check for $100. If the procedure or test is not covered or denied, the Aetna agreed pricing is $0 and Aetna pays $0.

Now on these particular lab claims, the Aetna agreed pricing is there, say at $100 and column three then says Aetna paid $0. So if there is an agreed price, why didn't Aetna pay that agreed price? Something isn't right with that. And I had planned to protest because this fishy claim b/s got me kicked out of the hospital lab and now I have to drive somewhere else and have it done. Not so easy with a two-year-old and, oh you know, Cancer. But after talking with the front office gal at the Cancer Center, I don't think it will do any good. The hospital lab has a policy now not to do Aetna patients from outside the hospital and the cancer center is not part of the hospital. So I can either call Aetna and bitch and still not get to have my frequent labs done on site or I can let it go and bitch here and to all my friends and still have to go to CPL for my labs. Sigh.

The appointment went well, though. We discussed the fact that last round I still spend the afternoon/evening/night of chemo pretty sick. And that taking the phenergan for nausea didn't result in any measurable relief from the nausea, but did result in me twitching for a several hours and unable to sleep. And then he told me that yeah, phenergan does that and that Benadryl can counteract the twitching and wiredness. I wanted to ask why the hell someone didn't tell me that when they gave me the phenergan in the first place? Man. So now I know to take Beneadryl for the twitches and phenergan for the nausea. Of course phenergan doesn't do much for the nausea, but I fear what things would be like if I didn't take it. Shudder

We also talked about how difficult the bone pain side effect is to control. I thought he would offer me some kind of pain meds that may or may not make me sick which would lead to more phenergan which may or may not help and may or may not give me the twitchies. But instead he offered a trial of doing this round of chemo without getting the Neulasta shot. Instead we will do a blood count that week and see how low my counts get. If they get too low, I will have to get a shot or three of Neupagen, the mother drug of Neulasta that lasts a day instead of a week. Neupagen may cause the bone pain too, but I am not sure how much.

But if my blood counts are acceptably low, cause they will be low, then we will not do the Neulasta from here on out. Which would mean possibly two feel-good weeks instead of one each round! That would be nice, but I suspect that my counts will be too low and I will need the shots. I just don't want to get my hopes up. It is worth a shot though. Ha ha, worth a shot, get it? Heh.

After the appointment, Mom and I took Jackson to the park for a bit. It was too early for work, but not enough time to go home. Jackson had fun throwing pecans in the water and climbing the slide - but not sliding down it - and swinging.

He wanted to sit in the big kid swing, but its precarious nature got him pretty scared. He kept saying, "It's ok, it's ok!" Which is what he says when he's scared. As opposed to "I gotcha, I gotcha", which is what he says when he is afraid of heights.

Then it was off to work where he slept a good three hours while the guys finished up the Lend Me a Tenor set and I worked to show Larry a few things in the office for when I am out next week. It has been good to be back this week. Tomorrow, Tenor opens and we have our opening night gala next door at a cute shop called Annarella. Got all the food donated by local restaurants and we'll serve wine and schmooze. It should be a busy Friday getting things ready for the show and gala. Then I am heading downtown to see a show at Stubbs. Hope I have the stamina to get through it all. I haven't had a late night out in some time. Should be fun.


Lisa said...

Hi Marsha. I found you via Ronni, she's a dear friend. I have been following your blog for a while now and I can second your emotion re Aetna. My husband used to work for a very large company and they had Aetna and good old Aetna denied absolutley everything the first time around. We're talking my annual ob/gyn exam, etc. I would have to call, bitch at them, cite the page in the benefit book that stated very plainly that it was a covered service and then they would make ME call the doctor to resubmit. Pissing off my doctor's office, wasting my time. I think it was a shameless ploy. They thought people would just get the bill, assume it wasn't covered, then pay it, so Aetna didn't have to.

And I wasn't even sick so I can't imagine your frustration!

Hang in there, Marsha.

I'm rooting for you.

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