BCBS Appeals Process and Radiation Side Effects

Talked with my radiation oncologist, and he’s going to bat for me regarding Blue Cross Blue Shield’s denial of coverage. He’s already gone through the peer-to-peer appeal/review process with the BCBS physician, and the BCBS physician is in complete agreement with my radiation oncologist–that this course of radiation treatment for me is medically necessary. But apparently, the BCBS peer review physician doesn’t have the power to overturn BCBS’s denial of coverage. Which really does make one wonder, what exactly is the point of having a peer-to-peer review process?

Next step is assemblage of documentation and a firmly worded letter to BCBS. My doctor has seen this before from BCBS, knows the paperwork and red tape hoops to hurdle, and is confident we’ll get the denial overturned, although it may take a while.

I’m glad someone knows their way around BCBS’s labyrinthine procedures. As I’ve mentioned elsewhere, for my day job, I edit legislation for the state, so I’m comfy parsing obfuscative and convoluted legalese. I’m not daunted by insurance forms and small print. But trying to get this sorted has thus far been an exercise in frustration.

And I’m not at my keenest or most patient these days. I was hoping the radiation’s side effects wouldn’t kick in for another week, but they seem to be in full swing already. I’m exhausted all the time. I wanted to get out this weekend to run some errands but spent it sleeping or somnolent on the couch instead. And I’m having a hard time concentrating and remembering things. I keep starting to do something and then forgetting what it was halfway through. I have a vague sense of being very behind on a lot of outstanding to-do items with a decided overlay of “overwhelmed” blanketing it all, but I can’t seem to focus on anything to the point of getting started.

Also, my throat is quite sore, my mouth perpetually dry, and I’ve all but completely lost my sense of taste. I’ve got a little bit of sweet left, but salt and savory are utterly gone. Sour is an odd amalgam of blunted caustic aftertaste and dim metal-chemical, oh, but I can still taste bitter. Yeah, the joy of eating, not so much.

I’m trying very hard to deflect my focus away from the underlying fear of “what if it’s permanent?” With chemo, I knew that nearly everything I was going through–the sickness and pain and nausea–was transitory, albeit there are some long-term side effects, like the onset of early menopause, that I’m still coming to grips with. With radiation, there’s a chance that I might not get back what I’m losing. What if my sense of taste is permanently wiped out? What if my cognitive impairment doesn’t get better? Trying not to dwell on it because I don’t have much of a choice. Gotta do the radiation to kill the tumor.

On an up note, while I can still feel the swelling where the tumor is, it doesn’t appear to be winning the race any more. My radiation oncologist said I most likely wouldn’t see the radiation’s shrinking effects on the tumor until the second or third week of treatment. We’re just at the 1.5-week mark today, and while the tumor is most definitely not shrinking, it has either slowed to the point of my not being able to detect its daily progress or stopped growing altogether. The pressure is still there, right on the verge of pain–I’ve had to take painkillers a couple times now to mitigate it–and the swelling has screwed up my bite alignment again. But at this many days out from the end of my first course of chemo in April, I was in constant pain and having to hit my prescription narcotics pretty hard to keep functioning.

Small steps. Moving forward.

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6 Responses to BCBS Appeals Process and Radiation Side Effects

  1. Mike Allen says:

    I’m glad you’re getting help appealing the ridiculous insurance ruling. All best to you and yours, Eugie.

  2. Gizele says:

    Small steps are advancement. I understand it’s difficult, my heart hurts for you, it can’t be easy to have no certain answers. Faith is often all we have to hold on to. I hope it’s not tiring to read people writing “hang in there” and “stay tough”. In this world where horrible things happen and the value of life in some places is of little importance, you are important to me. I wish every good thing to come your way and I do pray every day for a perfect outcome for you.

  3. E Krock says:

    So sorry you’re having to go through any of this. Let alone all of this!!!!! Easy for me to say, but take things one day at a time. Today’s problem is killing the tumor. “Chemo brain” is a well-known and common problem and generally improves once you’re not being injected with chemicals and blasted with radiation. Remember that stress and fatigue don’t help memory or cognition either. Things will improve. For now kill the tumor and let the future take care of itself. You’ve seen Gladiator, right? Let us know whenever you want us to “unleash hell” on BCBS in social media and otherwise. What they’re doing is unacceptable and nonsensical. They must relent or pay a reputational price if they insist on an indefensible position and THEN relent!

  4. Diane says:

    Leaving aside the fact that in a sane health care system, you would not need someone to advocate for you, I am so happy that your radiation oncologist is being such a strong advocate for you.

    I’m even happier to hear that the tumor’s growth seems to be arrested, and hope shrinkage will be detectable soon.

  5. Amy Herring says:

    Oh, Eugie,
    I am so happy you have these two great physicians on your side. Surely, they will get BCBS to overturn its ludicrous denial.

    As always, I hate what you are going through. As others have commented, you’ll have to see this through to learn whether these icky side effects are transient. Let’s hope they, and the tumor, are unwelcome houseguests who smell like fish, but will soon be going away permanently.
    Hugs, love, kisses, hope,

  6. Debbie says:

    I know someone who had radiation treatment for throat cancer, lost his sense of taste completely, but regained it after finishing the treatment. So try to stay positive and focus on zapping that tumor so it’s gone for good. I’m so sorry you’re having to go through all this plus the mess with BCBS. It sounds like the doc will get it straightened out for you, though, so try not to worry about it. Thinking of you often. *Big hug*

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