My Insurance.

Just one week after my prophylactic double mastectomy, which as you know, was made possible for me by the Affordable Care Act, I plucked up the courage (aka wine + valium) and watched President Trump’s #JointAddress and listened to Colorado Senator Cory Gardner’s #GardnerTownHall. Now I know you might be thinking, “this blog is called Nashville Sue and homegirl lives in Nashville, Tennessee, why on earth is she busy trolling a Colorado Senator?” Well, along with following the National and Tennessee debates on health care, I like to also pay close attention to what’s happening in Colorado because 1) I will always consider Colorado home, 2) my aging (don’t tell T-Rag he’s aging) parents live there, and 3) the side of my family where my BRCA2 genetic mutation comes from still lives in Colorado and that includes my 8-month-old niece.

After last week’s surgery, I spent most of my time living in blissful political ignorance, mildly hoping that when I came out of my Percoset/oxy/valium-induced coma, all the world’s problems would have magically found a unified solution and I would no longer have to worry about this complicated little issue called health care. (Side-Note: just because my cancerous tits are gone doesn’t mean I’m 100% out of the woods yet – more on that in a future post.)

As I have alluded to in my previous posts, this first surgery has been a total mind-fuck. After I finally grappled with the whole “I’m actually cutting off my tits” thing, I became absolutely and utterly exhausted dealing with the insurance companies. In fact, these past few months, after a glass or two of wine, I have spent countless nights questioning if this was actually a smart, healthy decision or if I was really just trying to hard-nose my way into getting a killer boob job.

Trouble first started when, mid-way through my decision to go ahead with the surgery, I ended up having to find a new insurance company because Blue Cross Blue Shield of Tennessee ended up dropping out of the exchange for 2017. Shockingly, I was able to find a policy with Humana that not only covered all seven of my current doctors, but I could actually mildly afford.

Little did I know, that when choosing a health insurance plan, not only did I need to quadruple check that all my doctors were in-network, I also needed to make sure that the hospital where both my breast surgeon and my plastic surgeon perform their surgeries was in-network. Silly me for assuming that the hospital where my in-network surgeons perform their surgeries would also be in-network.

So, one month before my surgery, I was left with two in-network surgeons performing a massive surgery that included an overnight stay at an out of network hospital. That realization ended with a long and tearful conversation with T-Rag and MJ about whether or not I should just wait and try to find new surgeons who were able to perform the surgery at a hospital that was also in-network.

Then, low and behold, after a tediously long call with Humana, where I was first put on hold for 45 minutes so the man could “double check” and re-confirm that a prophylactic double mastectomy was actually covered under my policy, he was able to find an in-network hospital where both my breast surgeon and my plastic surgeon had operating credentials.

Then, as luck would have it, cause I’m so gosh darn lucky, a week later I got an awesome phone call from my breast surgeon’s office informing me that my breast surgeon’s NPI number was in-network, but her tax ID number was out of network. Apparently, the NPI number is what is used on insurance companies websites/healthcare.gov and makes it possible for a patient to confirm that their doctor is in-network before they choose a plan. But their Tax ID number is what is actually what the doctor’s office submits to the insurance company before they can make the price adjustment. Normally, these numbers are aligned i.e. the NPI number and the Tax ID number are both considered in-network, but somehow, my breast surgeons Tax ID number was out of network and causing my insurance company to bill me as an out-of-network patient.

Yeah. That conversation actually occurred and ended with me screaming “that sounds like a pretty fucking big YOU problem,” after I hung up the phone. This new monkey wrench in my perfectly construed plan was then followed with another long, tearful, overly dramatic (on my part, always on my part) conversation with T-Rag and MJ.

This time, we decided to be patient and wait to see what different options the breast surgeon’s office could come up with. During this time, I was also able to have a long discussion with my plastic surgeon’s office, and they assured me that if things didn’t work out with my breast surgeon, that we would go ahead as planned and they would find another, in-network breast surgeon to perform the mastectomy. Thankfully, my patience paid off, and my breast surgeon was able to work with my insurance company and bill me as an in-network patient.

As you can see, I jumped through a lot of fucking hoops to get my cancerous tits chopped off. I spent countless hours talking on the phone to insurance companies, who for some reason simply can not fathom how a prophylactic double mastectomy is actually covered for a seemingly healthy 27-year-old.

And, inevitably, like every single one of my doctor’s appointments over the last 5 years, each phone call with the insurance company always started off with the same questions: “Who in your family had Breast Cancer? How old were they when they were first diagnosed with Breast Cancer? Are they still living? How old were they when they died from Breast Cancer?”

Even after 18 years, I still cry every time I have to tell a stranger that my mom died when I was 9 years old and that science has told me that I will most likely get the same disease that killed her.

But, cry no more! Not only am I absolutely ecstatic knowing that I now longer have to have that incredibly painful conversation. I am also forever grateful that President Obama has made sure that I, along with my niece and any future nieces, are all covered under the Affordable Care Act. Those two things, along with the whole no cancerous tits thing, have made this whole shit show absolutely worth it.

Don’t get me wrong, I will be the first person to l tell you that the ACA is broken and needs to be fixed. Hell, I’ll even support “TrumpCare” if it will actually lower my premium while still providing me with the same quality of care. But there is a huge distinction that must be made before I will ever begin to support the repeal/replacement of the Affordable Care Act.

Last night, President Trump and his speech writers* carefully articulated; “we should ensure that Americans with pre-existing conditions have access to coverage.” Then again this morning, during his tele-town hall, Senator Gardner reiterated this verbiage when he promised his constituents that he would continue to make sure that Coloradans with pre-existing conditions would always have “access to coverage.”

Now, I said all of that to say this: Please, I beg you to understand that “Access to Coverage” is NOT the same thing as making it ILLEGAL for insurers to DISCRIMINATE against Americans with pre-existing conditions. The Affordable Care Act already ensures this for millions of Americans and it is part of the reason why repealing and replacing the ACA is a very daunting and complicated task. Sure, my monthly premium is almost half my rent and my deductible is more than my monthly salary. But right now, under the ACA, this higher cost of my health insurance has absolutely NOTHING to do with the fact that I have the BRCA2 genetic mutation.

I know that this post got a smidge political, but I really wanted to share with y’all what it really took to make this surgery possible. I have physically been recovering incredibly well, but since my parents and BFF left this past weekend, I have become mildly anxious, and the thought of being around large groups of people seems incredibly daunting.

So I have spent most days hiking and writing. I am currently drafting another post for Friday, explaining what exactly happened during this first surgery, along with an explanation of my recovery and my second reconstruction surgery. Finally, I have somehow found the courage to dive into my mom’s battle with Breast Cancer from a medical standpoint and I hope to also include some of those details in my future posts.

I am eternally grateful for everyone’s love and support, and I cannot thank you enough for giving me the strength to actually go through with this. Love you all very, very, very much! – Sue

*Start listening to the podcast “Pod Save America,” it will change how you listen to politicians speeches.

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