It's Official ...

I've made one more year. The results are in and my PSA is officially pronounced, "Undetectable! Perfect!" And a DRE confirms that healing has gone well.

My only disappointments today were first that insurance made a simple follow-up an exercise in frustration, aggravation and mediation. Secondly, the fact that I have to go back every three months for another year. Then every six months for the following three years. Of course that puts me on the path to a quarterly encounter with the insurance.

Back in December I went through a bit of a hassle getting a referral for a follow-up in January. They questioned, "why would you need to go back now? You were just there two months ago."

I had to explain that the doctor wanted three month follow-up visits and PSA tests to watch for the possible appearance of metastasized cancer. They sent the doctor a referral for two visits. Sounds like a good deal to me. When I went to get the blood test I was denied because it had not been THREE months since the last one. So I rescheduled my appointment with the urologist and my blood draw at the primary care physician. When I went back in January the blood test went well and I had no issue at the urologist.

My good fortune in that matter was an illusion. When I went to my primary care physician for the blood work again, they were questioning why we were doing it in April when we just did it in January. They checked and it was OK since it was April 30, the anniversary of my surgery.

Now it's May 7 and I went to the urologist for my 8:15 am appointment. I should have been in and out in fifteen minutes, because it was early, before they could get behind. No, there was a problem with my referral. It had one more visit open on it; but, it expired on April 30. (The date I needed to wait until to get my labs done.) The urologist's office had requested an extension on the thirtieth but had not received a response yet. The receptionist called the insurance and the doctor's group.

They weren't open. The voice mail said the they would "open promptly at eight-thirty a.m."
Of course they didn't. In fact at nine o'clock they weren't open, at least not answering the phones. I called my doctor about five after nine and Renee, there receptionist, was going to call a direct number and see if she could get it faxed to the urologist right away. So we waited.

I was just headed to the public men's room when my cell phone rang. Renee was explaining to me that she spoke to Violet and they were not able to fax the referral at this moment, but they would do it TODAY. I asked if she would mind explaining that to the office staff here because I didn't think they would believe me. She agreed and I handed my cell phone to the receptionist. They finished their conversation with the receptionist asking for a number where she could reach Renee and handed me my phone. I was all set. She would get me in to see the doctor as soon as possible. Of course this is one hour, forty-five minutes after I arrived and one and one half hours after my appointment.

"Pee in the cup, put your name on it and place it in the cabinet, please. You'll be in room one when you finish." Or words to that effect.

Wow! Peeing never transported me to another room before. I know she didn't misspeak. Syntax and alternative interpretations amuse me. I came out and went to room one and sat down. About five minutes later the same little girl, about five feet tall if she stands straight and petite, come's to the room and says, "Oh! There you are. How did you get here without being seen? I was right there."

I said, "I don't know; I'm pretty hard to miss." (being six feet two inches and and two-hundred seventy-seven pounds I don't usually slip by) She took the usual history, asked if I had my PSA tested and a list of my medicines and said the doctor would be in soon.

He was and said I was perfect. He wanted to do a DRE (I thought I had the last of those when they took my prostate out). He wanted to check on the healing, if the ureter healed well, with little scaring. He said it was great! I'm not sure how he meant that. I didn't think it was special.

Then he tells me he'll see me in three months. "THREE MONTHS?", I said. "I'll have to fight for that then."

He asked, "Why would you have to fight for that?"

So we had the discussion about referrals and about the hard time they gave me for seeing him every three months for the past year. He said, "You had cancer, for Christ sake you need to follow-up to monitor your health. It will be every three months for two years, then every six months for three years. Then annually. You want to be sure you're over it."

I tell you this NOT just to bitch. I'm telling this partly to let you know I too have my hassles with insurance. But, also in hopes you will do as I am doing and contact your insurance. We need to inform them that their process is BROKEN. Common sense should tell them that there is a linear sequence of events. Blood draw, lab work, result to doctor, referral to doctor, patient to doctor. It should not require the patient to call for each step and schedule the insurance office processes. We should not have to get approval for every step of the protocol individually. If they are covering treatment, in my case prostatecomy, then they should write a referral for the protocol.

Most people are aware that it is five years before doctors will talk about "cured". As process oriented as insurers are today, I would think they have a protocol for every treatment plan that they agree to pay for and the medical professionals agree is a 'standard' protocol. Having been diagnosed and verified by multiple tests the course of treatment being chosen and approved, the insurer should write the referral for the five year plan. The only caveat should be that I show up ALIVE and still insured by them.

The insurer has the trump cards. If I should die or be terminated by my employer or change insurance, or other wise lose coverage they can deny the claim submitted by the physician. If he was fraudulently filing claims and they deny it the doctor is not harmed because he didn't perform a service for which he is not paid.

Like the movie line, "I'm mad as Hell and I'm not gonna take it anymore!"
Call your insurer. Write your insurer. write to your state's Department of Insurance. Contact your legislators.

Be healthy and enjoy life. It's up to us to respond positively to stimuli. Keep smiling.

Twenty Percent Down!

It has been a year since my surgery. I didn't even have a twinge as my anniversary passed. Although I did think of it. As the medical transcriptions would say, "After recognition of the day the remainder was unremarkable."

The insurance got very particular about the precise day they would authorize lab tests. I must be at least ninety days since the last draw. And the same with the office visit. So I have had the blood test. I have an appointment for the seventh of May for the results.

Insurance of every type tries to run every one's life to avoid disbursement for claims. They live by premiums and die by claims. So understandably they don't want people to use them to frequently. They have to walk a fine line between 'practicing medicine' and managing claims.

To that end, my health insurance company changed their listing of several drugs in January. I had been on Lipitor and Zetia and Tricor for blood lipid level control for five years. My results were excellent. LDL <70,>45 and Triglycerides ~ 120. My nuclear stress tests had indicated no new cardiac blockage. My carotid artery ultrasound was very good.

The insurance sent a mailing out that Lipitor would go from $30 co-pay to $100 co-pay. There is no generic equivalent for Lipitor but they "suggested" Vytorin or another statin-family drug. The doctor wrote me a prescription for Vytorin and Fenofibrate, to replace the Lipitor, Zetia and Tricor. Thus I needed to test again in ninety days.

I made an appointment for April to combine all the blood tests for liver and kidney function and lipid levels and PSA for my Prostate follow-up. That week news broke about the ineffectiveness of Vytorin and of Zetia. They do lower the cholesterol level but don't stop blockage and in studies blockage increased. That pissed me off! In the interest of profit the insurance decided what drugs I could take; not my doctor.

Then I realized they decided what they would pay for which products. I decided what I would pay for which product TOO! But not to white wash the insurance company, they didn't lower my premium. They kept the profit and I had to give up more money or possible health advantage.

The test results came back and the doctor called with the news. LDL=64, HDL=48, EXCELLENT!! Liver function great! Kidney function good! PSA, undetectable!! I still have to go to the urologist for follow-up. Possibly as much for his edification as for my benefit, since I know there is no adenocarcinoma from my prostate. I should be good for another year. One down and four to go.

I looked into the Vermont thing. I thank you for thinking of me. I might consider it later. I am focusing very hard on wrapping up my career this year. I want to retire with benefits for me and my bride. At least for my bride. And I'm not sure what to expect from organizations for support.

Whether for heart, diabetes or cancer; I don't really feel worthy of a support group. I think of my self as much like I was; but MORE worthless. I don't feel like I survived a major heart attack that kills 43% of victims. Or that I have, knock on wood, gotten apparent control of my diabetes. Am I a cancer survivor? People in those support organizations seem to all have a story so much more worthy than I do.

I didn't have OPEN HEART SURGERY! I didn't have the anguish of being diagnosed with cardiovascular disease and FINALLY deciding to have my five arteries with 85% to 90% blockage bypassed. I didn't have to suffer the worst pain in my life. I didn't face death. I didn't almost die multiple times.
I only had one dominant right artery blocked 100%. I watched them push the dye. I saw the blockage. I saw the doctor place the stent. And it was so easy! I got the best drugs in the world for pain as I lay flat of my back under a sandbag while a tube ran in my groin to a balloon in my heart that inflated and deflated to pump my blood through my heart. I never felt like a victim. My nurses and doctors treated me with respect. Their touch felt so sincere. Their words were comforting when they told me how tough I was and how I could ask for anything we needed. And Sally sat there in the mind numbing boredom from the Wednesday night I went in to the Saturday morning I got out.

MY cancer was without manifestation of symptoms. It was discovered via my annual check-up blood tests. It was only moderate grade, the Gleason was 3+3, contained within the envelop of the prostate and unremarkable (one of my favorites of doctor descriptive words). I had a good bladder neck left and nerve sparing went well. I worked very diligently at bladder control and regained total continence in five weeks. What could I offer in support?

Every one there would have gone through so much more than I that I could not offer understanding, encouragement nor hope. The other day I received in the mail an invitation to Cancer Survivors, to attend a celebration of the hospital's award winning Cancer Center. Sally looked at the mail and said, "Huh! I never thought of you as a cancer survivor before."

But thanks for listening. I am just a very blessed old fart.