Potentially, tentatively, cautiously optimistically, VERY good news! (NOW REVISED, NEW AND IMPROVED!)

This is Jason doing the writing, not Jane. I am hijacking to deliver potentially, tentatively, cautiously optimistically, VERY good news!

Shannon got a call from the MDA Proton Center denial of claims coordinator. If I understood this right from Shannon (and she may want to clarify), after rejecting us a 2nd time on Friday, United Healthcare took it upon themselves to forward the case on to the third level of review. The third review, as now required by "Obamacare" has to be an 'external' agency. In this case, United apparently has arranged to use ERS, the organization who hires them to run our insurance program as the 'external' reviewer. In public accounting, that would be called 'self-review threat', and would be easily recognized as unethical, but I digress. In any case, apparently when the third review was sent, it was quickly turned around with a response to pay for proton therapy! The MDA lady said that she was called by the insurance company and that they had caved! We have NO IDEA yet what caused that effect. Shannon has written to ERS Board members, and that may be the cause. It could be that they liked our appeal letter, and found Shannon's financial argument persuasive. Who knows!? (UPDATE: I just received a call from John Frullo, our Texas Representative for District 84, followed by one from his staff person Robin. This issue has been explored by them, as he chairs the House insurance committee (if I understood correctly). They have been looking into the quality of care received by Texas employees. He called to say that we can expect some good news from United Healthcare. Robin explained that they have been following the blog for a month or so. So, THANK YOU JOHN (and PATTY)! This is just incredibly helpful!)

This is fantastic news, obviously. But with all things bureaucratic, we have to believe it once we see it. (UPDATE, having heard from John Frullo, (who agreed about bureaucratic challenges being omnipresent), I am inclined to believe it!) A few days ago, Shannon signed a routing information slip so that money could be wired to us. Nothing so far, but we are still holding our breath.

There is a LOT that remains unknown. For example, we don't have any clear picture of the total bills to date that we may owe MDA. It seems possible that they will deduct those fees prior to reimbursement. We also do not actually know what the next treatment step will be when Shannon gets scanned on May 23, and if that will involve another round of very expensive...something or other.  Nor whether, if the insurance really pays for proton, they will pay for another round if required for her treatment. As you see, I am learning that in a medical crisis, even with very positive news, it just allows you to move on to the next onslaught of concerns! But for now, we are optimistic.

Because Shannon is Shannon, the first thing she said after telling me was, "Now we have to make sure that this wasn't just an exception for me. I want this to be policy. Email the attorney." So, yeah. There are lots of people without our resources, support and fortune who could not get this result. They do not deserve to have their brain irradiated and their cognition impaired permanently when there is a better treatment available for maybe 25% higher cost. As I have said many times, when body cells are irradiated and killed, they can grow back and tissues can recover. Neurons don't do that, so you just get collateral brain damage. Not fun. Especially tragic when that's clearly avoidable.

Our favorite patient is hopefully napping right now. Exhaustion has set in, although it doesn't keep her from struggling forward! 

One final note. The support of all of our friends, in so many different ways, has been...tear jerking. Yup. See? It happens instantly, as soon as I think about it for even a moment. Thank you all so much, even if you are just reading the blog and have not had a chance to say hello.