Wednesday, September 29, 2010

Hey...I Benefited from the Health Care Bill !

Over the last few weeks, I had been bantering with my Preferred PPO Health Care Plan about payment for my upcoming Breast MRI. I had been told that in order for the PPO to pay, they needed a current inconclusive mammogram. (I won't rehash the idiocy of the logic, in light of my present diagnosis and determinative tests that were needed to confirm same a year ago. For those gory details, refer to blog entry dated September 23, 2010.)

As we parried and thrusted on the issue of coverage, the Health Care Reform Bill took effect. Voila! This past Monday I was on the phone again for round four with the insurance company (the MRI was scheduled for the next day). Before I could get my vocal chords warmed up I was met with: "Ms. TC, we were just going to call you. We have looked into this matter and of course since it is medically/diagnostically necessary in light of your condition we will most certainly be covering the MRI. We are insurance administrators, it is not for us to determine what is medically necessary for you. If your oncologist has determined that the MRI is a medical necessity, then all she needs to do is put in the correct diagnostic code and it will be covered. Our apologies if there has been any confusion on this issue. Again, medical necessity is determined by your physician, not us."

WOW!!!! No kidding, no sarcasm...the above narrative is as true a retelling I can provide without a court reporter!  The only "change" or intervention that had occurred between my September 20 conversations with Blue Cross/Blue Shield and my September 27 conversation was the implementation of the Health Care Reform Bill. Yes, I had been doing my best B.O.W.* impersonation. I do not flatter myself with having been the cause of their change of heart (or profit ledger).

So there you go. Now if only they would have taken the blasted test for me it would have been a truly wonderful thing!

* B.O.W. = bitch on wheels

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