“He needs this procedure or his surgery can’t happen next week. What are our options?”

After seven months of chemotherapy and radiation, we were preparing for the first of Duncan’s surgeries to remove what was left of his tumor and affected lymph nodes. The week before his scheduled surgery, he needed another colonoscopy so his surgeon could see what remained of the tumor and finalize his surgical plan. Unfortunately, this procedure was unsuccessful because the tumor was still too big to maneuver around. 

Minutes after Duncan woke up from the anesthesia, his surgeon ordered a different imaging test to take place at the hospital next door to the surgery center where we were. It would also require Duncan to have fasted, so he couldn’t eat or drink anything until the procedure was done. The staff were ready to take him right away, but we had to get insurance approval before they could actually put him in the machine and gather the images the surgeon needed. He called the scheduler in his office, who called the hospital and then me. This kicked off a back and forth of phone calls between her, me, the hospital, and our insurance company to get the procedure approved.

Eventually, we had to leave the surgery center because they needed his spot for another patient, but we couldn’t go home because we needed to be ready to go to the hospital next door as soon as our insurer approved the procedure. So, we drove to Duncan’s office nearby and sat there while I continued to navigate phone calls back and forth until the insurance company finally said yes!

Later that week, Duncan needed to have an MRI to confirm everywhere there was cancer, so that it could be removed during the surgery. We had made the appointment weeks earlier and his surgery couldn’t go on without these images. That morning, the imaging center, the only one within an hour radius that had this particular MRI machine, called to tell us the insurance company still hadn’t approved the MRI and we would have to reschedule. At that point, I said, “He needs this procedure or his surgery can’t happen next week. What are our options?"

I was told we could try calling the insurance company directly to expedite the approval process, or we could waive our insurance and pay about $2000 out of pocket. So… I picked up the phone once again and began making all the calls. After a whole lot of stress and back and forth with doctor’s offices, imaging centers, and the insurance company, we thankfully got approval, and they squeezed him in the next day so his surgery could proceed as scheduled.

There are so many other stories I could tell about dealing with pre-approvals, unexpected bills, and other insurance issues. Without any training, caregivers are often required to take on the role of insurance navigator and medical billing expert on top of everything else they are doing. It's a part of the role I found particularly frustrating and stressful.

Ideas to consider: