Blink of an Eye

Alright... if you've been following this blog religiously, then you already know that my life can easily change in the blink of an eye. If you happen to skip a day or two in logging on, I'm probably in a different part of the world with a different diagnosis and maybe have even completely changed my identity.

Right now I'm sitting in Dave & Cary Schwartz apartment in Indy. I should be asleep, but I woke up panicked that I told Anne & Joel the wrong time for our outbound flight to LAX. Guess what? I did. Tomorrow morning (I mean in a few hours) my lovely sister and her husband are picking us up and taking us to the Indy airport. We will be flying into LAX and are scheduled to arrive at 9:35 California time (I think Cali is 3 hours behind us, so it will really be noon our time). Jeremy Lugbill is picking us up at LAX. We were planning on just chillin' in Cali and seeing some sights but...

The way this has all worked out is just so crazy that it is hard to absorb! Loma Linda University Medical Center (one of the two remaining proton radiation centers in the United States) already has my records and is seriously considering taking my case (they were uncertain at first because of the whole "stage 4" label). Dr. Luu (Sorry... new name. Basically the Dr. Thornton of California) doesn't normally see patients on Tuesdays, but given the circumstances, he scheduled a consultation appointment with me for today. So, sight-seeing: out. Hightailing it west-bound from LA across the 10 to Loma Linda (near San Bernardino) to LLUMC/Dr. Luu: in. Consulation should be a snap. I've only had like 3 of them already. I'm not sure what he can tell me that I don't already know and have bound in my color-coded, chronologically-ordered medical binder.
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Cali's proton protocol is about the same as everyone else's. Consulation, followed by planning appointment (where they do a CT scan of you in the mask which they use to run numbers to get measurements to write their radiation plan), followed by 3-4 weeks of wait time while the doctors/physicists run the numbers through the computer and write the radiation plan, then radiation can begin. LLUMC, however, is a much larger facility and indicate that they can usually get out a plan and start radiation within a 3-week window. Of course, the plan can't run if I don't have the CT Scan/mask made. Crazily enough, they usually scheduled the consultation and planning appointments back-to-back over a two-day period. There were absolutely no openings for a morning planning appointment on Wednesday, though. Mary Ellen (who will be my case manager in California) made a couple of phone calls and found a local patient who could take an afternoon opening so that I could take an 8:30 a.m. and just maybe make it back to LAX for our flight to Honolulu. (I haven't heard how long that appointment takes, but I've done this same thing in Goshen and it took a few hours). If we leave LLUMC at 11:00 a.m., we are looking at an hour or two in west-bound traffic since we're headed into LA on one of the busiest expressways in California. That puts us at the airport at 1:00 and our outbound flight is scheduled at 2:35 (can someone remind me to verify that time b before 2:00 a.m. the night before the flight). There's only one thing, one person, one veritable force of darkness that could stand in our way....... Anybody want to take a guess?

ANTHEM!!!!!!!!!!!

So, originally Anthem told us that my pre-determination was approved -- that I was approved to receive proton radiation, no matter what facility I go to. "It isn't the facility that is approved, it is the treatment," according to Stephaniem, head of Anthem pre-determination/UM Services (She is an enigma. No one has ever seen her, but evidently she holds the power). My case merits approval for this special radiation (duh... it's like the only option). I already have a pre-determination approval letter in my hand (in the color-coded, chronological OCD binder) It says proton radiation is approved but lists Dr. Thornton and MPRI in Bloomington as the treating physician/facilty. When we first learned that this change of venue could take place, we called pre-determination immediately back they said there should be "no problem" transferring facilities for treatment. Now that this transfer seems plausible, they are back-pedaling. Evidently LLUMC uses some different "codes" for their treatment than Bloomington uses. These codes are listed on the pre-determination form. If the codes change, then we would have to start the pre-determination paperwork all over again from scratch and we're back to the whole "we're behind on pre-determinations by 4-6 weeks response." So, Ru and I were set to walk out the door at 3:10 and head out to Indy. Instead, I had to compose a panic-stricked email to the all-powerful Doug Hasler (Elkhart Community Schools attorney) and update him on the fact that I may need him to go to bat for me again -- I'm pretty sure he worked on this for two days for me just a week ago. UGH!

Once again, LLUMC can see me in consultation on Tuesday, but they cannot really touch me on Wednesday unless they know they are going to get paid from someone. Mary Ellen was going to try to push this through quickly. Maybe, just maybe, since they've already established that proton radiation is medically necessary and all they've got to do is change some codes and print out a new form, they can expedite the thing and get the letter/verbal approval to Loma Linda tomorrow. This time I was one-step ahead of them, though. I asked up-front about the option of paying for this planning appiontment myself and waiting for reimbursement from Anthem when it is approved (there is not really a question that it will be approved; it's simply a matter of how long before the approval is in our hands). Well, Mary Ellen says that "may be possible", but they bundle the consultation appointment and the planning appointment and bill them together, so I would have to be prepared to pay for both up-front or work out something with financial services and it would be "a lot of money."

Does anyone out there have any idea of how to quantify "a lot" from the standpoint of a medical provider? I have a Visa Platinum, but I'm pretty sure if they gave it to me, they're giving them to everyone these days and the platinum thing is no longer really signifies that I'm some precious metal and worth a exorbitantly high credit limit. I don't know what they should have really called my Visa. Perhaps they could have named it "Just enough to buy a really nice king-size mattress" Plus, Visa platinum has been busy booking flights and hotels and paying for doctor's co-pays.

I write all this to tell you I guess there is a slight chance that my next post could read "Help! I need to raise $15, 345 by 8:30 a.m. tomorrow!" (At least that gives us until noon in Indiana and the bank will be open....good thing we already got that charitable account set up and running :) Alright, if you are following along, I would sugggst you just get DSL and stay connected. I have no freaking clue what is going to happen tomorrow (I mean today).