30 Years Have Come and Gone

It's hard to believe that this day marks my 30th year on Earth.  I've had so many amazingly wonderful memories over the years and I'm hoping for many more to come.   I hate to harp on my near death experience once again, but having an event like that happen really does change you, or at least it did for me.  Now when I do something, I want to have the fullest experience possible and I want to leave a lasting impression of someone who truly enjoys life.  Whether or not I'm accomplishing this, I don't know, but I truly hope I'm making this world a better place to be. 

 I am so blessed to have traveled the road I have in this life.  Even though there were some hard times, I have been refined and come out on the other side with a thankful heart.  I am surrounded by people who love me.  Family and friends who have stuck by my side when the going got rough and have laughed during all the fun too.  I have a truly amazing man for my husband and God has given us two beautiful and wonderful children.  I can't imagine the years to come being any better than the last 30, but I know God has great plans.  ;)

Final Approval

So I received the final approval from the Healthwell foundation today saying that I have a $15,000 grant waiting for me to use on my copays.  It looks like the way it works is for me to pay the cost upfront and then submit it for a reimbursement from Healthwell.   This is amazingly fantastic news and I'm so utterly relieved that I don't have to worry about this issue any more (at least for the next year).  It looks like a reimbursement program where I would pay the upfront copay and then submit a claim form to healthwell to get reimbursed for the cost of the copay.  I'm not entirely sure that's the case but I plan on calling them tomorrow to iron out all the details.  And now it's time for a collective sigh...Aaaaaaaah.  :)

Oh, Praise Jesus!

If you know me at all, you know I'm a 'thinker' and not a 'feeler' which means that me having shed tears over a piece of mail is a big big deal.  Well that just happened! 

I spoke with the person in billing who is working on my case at the hospital today and she said that she is going to contact my insurance and figure out why they are not considering it an outpatient service when an infusion is clearly an outpatient service.  She said she thinks they might just be interpreting the coding incorrectly and she's hoping she can get it straightened out, but she made it clear that all insurance companies run things differently and that she wouldn't be able to say for sure if it would be $125 or $917 until they actually had a payment in their account...which could take who knows how long. 

So then I pick up the mail on my way home from a fundraiser (at Culvers, which was super fun btw) and I open up a letter from the Healthwell foundation.  As I said in my last post, the lady at the rheumatology office thought the foundation paid up to $7200 in copays per patient per 12 month period....which would leave me with about $4k out of pocket if the infusions are in fact $917 each.  Well, the letter from Healthwell is a pre-approval letter which states that my grant amount is $15,000!!!  The grants are also retroactive for 30 days prior to your application, which technically would not cover my first infusion, however this states that my coverage period is from 8/28/13-8/27/14.   Guess what date I had my first infusion???  That's right, 8/28/13!  How incredibly amazing is God?  I mean seriously, he deserves a shout out for this one!!!

Prayers Please

Well to make a long story short, the hospital billing department has billed my infusions in such a way that my copay will not be the $125 that I had been told but instead it is 20% of the medication cost which would be $917 per infusion.  I am currently trying to talk to the billing department to get them to bill it as an outpatient service (which has a flat fee copay through my insurance of $125 per infusion) instead of billing it as a part B medical coverage (which is a 20% rate of about $5k per dose of medication).  The last step I made today was to leave a message for the billing person and I'll call them again tomorrow to bug them, but I'm really praying they can change it to the outpatient service fee instead. 

I did get preapproved to get a grant to help cover copay costs from a non-profit foundation called Healthwell.  However the rheumatology office believes that they cover up to $7200/year for copays and if they are $917 each then in a normal year (without loading doses) that would still leave me with a difference of $4,721 to make up somehow.  Please pray that they will change the billing method and this will be an easy fix!