Tuesday, April 18, 2017

Insurance; Infusion site, Conf. Call (Insur Co heads, Team). new Neurosurg. Appt.

Earlier today, after what felt like a mad dash to get my infusion going (my Nurse was amazing!) and things settled I had a Conf. call with the Dean Insurance Med Team as well as my Case Manager from Genzyme called so we could talk ahead of the conf. call.
Altogether there where  6 people from the Insurance Company as well as my Case Manager from the Biotech Company (Genzyme) that markets the Enzyme infusion drug I receive every wk. If I remember right it was the overall Insurance Company Medical Director, the Infusions Medical Director, the Pharmacy Director (all for Dean Insur.), my Insur. Case Manager (for Dean), my Case Manager for Genzyme as I mentioned above and admittedly I am forgetting who the 6th person was from Dean. Impressive though that all these people took the time to call in and talk to us!

Non-the-less as Amy, my CM said to me when we hung up from the call and she had called me back (on her day off no less, I am blessed to have her on my Team!) she has been on a lot of these types of calls with other of her Genzyme Rare Disease Pts and never before has she been on a call where so many from the Insurer took the time to familiarize themselves with the case  or the history. For that I was and am very grateful. All seemed to chime in, answer my questions and bring up very good points or things they are working to have in place. Although it's very likely it will be denied at the very end of the Conf. call (about a 1/2 hr in length) my Dean (Insurer) Case Manager (CM) mentioned I can request a new Prior Auth (PA) be done (I have) to request re-approval at FMLH to continue infusing there. This likely will be denied given Dean's push to bring Pts in-network, to their sites but then she also mentioned we can write up and submit a "appeal" to any denial if we wish.

Ultimately although yes I do wish my infusion where staying at FMLH as they have experience and have been able to manage my (especially) cardiac-fluid issues without needing to stop or miss any infusions I can understand why it is a huge benefit even to us Insur. plan holders to go in-network for the infusion as the cost savings to Dean each wk is very significant (roughly $42,000 now a week at FMLH where it was roughly $13,000/wk when Dean paid for the drug before it shipped/I infused). I'll also still be able to get it out of network when in-pt say if at UW or CHW.

I guess if I'm going to find any light in this (believe me I'm really not, I really don't want to change sites, the drive to FMLH is MUCH easier than is the drive to the Fish Hatchery site every wk) but my PCP works at the FH site so if there where any issues other than the 3mo span she'll be off (maternity leave) starting around July she'd be able to (her words) come over/help manage any issues.
On a different note (sorry this is ending up a lot longer than I thought) Peds Neurosurgery called Monday and a new Appt is set for a few wks from now w/Dr.Iskandar. I am not entirely sure what she meant but seems he's reconsidering/maybe has something else in mind (maybe she meant he wanted to re-test the shunts again? I'm not to sure, I was driving when the Secretary (Anna) called though I did pull over). Anyways so any prayers appreciate that goes well.
I think I may have wrote about it in the last post but he emailed me he was reconsidering the ICP Monitoring which I agreed with. Thinking about it since then I think even if we did do this him and I have to have an agreement what #'s range he would be looking for to in-fact show 1 of the shunts isn't working (which the shunt taps seemed to show). I and Dr.Bragg know well what (very small, very low) range I feel best at but I'm still uncertain if Dr.Iskandar completely gets this.


Will update sometime soon.
Hope everyone had an Happy Easter! He is Risen, He is Risen indeed!



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