Still No MRI (but I love my radiation oncologist)

The surgeon's scheduler called yesterday morning to say that though ABMG is telling us five to seven days, it's been their (the surgeon's office) experience that it takes them 15 to 20 days. She also said they had a patient who was even more clearly indicated for an MRI than I and it had been refused. They got it sorted out with the help of the insurance commission, but still. Given that Dr. Kuan felt this hard mass almost a month ago (1/15), that kind of delay is heart-breaking.

My lawyer was at home when this call came, and after taking this news from the scheduler asked me if it was time for a letter. I wholeheartedly concurred and we cranked out a letter yesterday to: the CA insurance commission, Blue Shield, Alta Bates Medical Group (the gatekeeper*), and the surgeon's office. The upshot of the letter was that this delay is unconscionable given that the surgeon, the oncologist, and the radiologist all agree it's indicated. And that if my cancer moves from a stage 2B/3A to a stage 4, and it's determined that ABMG's delay had anything to do with such an "upgrade", this letter is our stake in the ground. It's wearying, really. Conflict is not fun, but neither is letting bullies push you around, so here we are.

Meanwhile, my radiation oncologist, aptly named Dr. Champion, is frustrated and thinks that this is terrible (yay! for validation). She's going to contact Dr. Wong (the radiologist who recommended the MRI in the first place) to see if he can't just do a biopsy. And that would be lovely. So we'll see.

So, there we are. Once again, I'm weary of talking about this. As Frank noted, I am the Worst-Case Scenario Girl, and since the worst case is pretty icky here, I prefer just not to go there at all. Thank you for your continued grace and patience with me as I go about my "let's not talk about this until we know what we're talking about" stance.

*A brief explanation for those not enjoying my type of insurance. My insurance company is Blue Shield. I've had absolutely no complaints about them. They've been wonderful throughout. Likewise, my doctors--all absolutely wonderful. The problem has been the intermediary--Alta Bates Medical Group. Basically, Blue Shield pays the bills, but does not review all my claims, ABMG does. So, in a typical situation, the doctor prescribes a course of treatment, ABMG reviews and approves (or denies) it, and Blue Shield pays the bill. I'm assuming that this middle man gets some sort of cut, or gets some sort of compensation, and that expensive treatments take a bite out of their profits, and so.... something like an MRI (which is somewhat expensive) is dissuaded. My lawyer husband calls this "institutional delay" and it's not something they should be doing. But I think we all know that it's about the bottom line, and whatever a company--any company--can get away with, they will. Unfortunately, we're talking about someone's health here, which makes that posture even less palatable than ever.