Jasper and the Beanstalk (Installment 2)

Last time I jotted down some notes about our great growth quest was around 3 weeks ago.  That was a couple weeks after the last contact we had with  Doctor Tebbin at Mayo.  He said we’d be hearing from someone in a couple weeks.  What he said was, “If it’s Ok I’ll pass your information onto  Genentech, who does a good job negotiating with the insurance company.  The case is pretty clear cut, he’s had the gold standard of testing and he’s 16  years old.  You’ll probably hear from them in a couple weeks.”    What I heard was different.  I heard, “If it’s Ok I’ll get your information to blablabla (where I inserted a random hospital department which deals with the ugly financial stuff).  It’s an expensive treatment and insurance always balks, it’s a pretty clear cut case, you should hear from them in a couple weeks.

I spent those two weeks figuring we’d be starting growth hormone shots in about 2-3 weeks.  Remember, we’ve been working this angle for almost a year and we finally have an answer.  I even bought two pairs of skinny jeans for Jasper’s birthday.  One pair was a size 12 slim and the other was a 14 slim.  The 14 slim was so he’s have a pair to wear when he grew oh-so-quickly out of the size 12’s.  We bought tap shoes in a slightly larger size than he needed so he wouldn’t outgrow them.  We made plans to take his picture every day.

It turns out that Genentech isn’t a hospital department.  It’s a pharmaceutical company which makes the growth hormone prescribed for Jasper.  When they contacted me in two weeks we were no closer to getting the shots than when I talked to the doc.  They needed to email me a release so I could print it off and fax it back to them, giving them permission to see the pertinent information and to talk to Blue Cross Blue Shield.  I did this that day.

That was 3 weeks ago.  I called yesterday to get an update since we need to decide about our Flex account money this week.  If we’re paying out of pocket, we’ll need to max out the Flex money.  Lila at Genentech is always nice and professional, and slightly vague.  I asked her if she had an update and I told her why.  She assured me that she was in weekly contact with BCBS of MN.  I asked what that meant.  She said again that once a week she was in contact with them, usually on a Thursday, to see if there had been any progress.

I couldn’t figure out what that meant, really.  Did she go check a website every Thursday morning?  Did she send an email? Did they send an email to her?   Did she call someone at BCBS?  Did they call her?  When I pressed she said that she actually spoke with someone at BCBS every Thursday to find out if they had made a decision.  So far, they had not, but it generally takes 30 days. That puts us at the end of November, which is bearing down on us here, pretty soon.

What’s more, if they deny, we can appeal.  Appealing takes up to 6 months.  I’m getting crabby.

What the heck is a pharmaceutical company doing negotiating with my insurance?  Shouldn’t that be the doctor’s job?  Or mine?  And when Lila asked me not to call the insurance company because it usually confused them and slowed down the process, why did I listen to that?  It all smells funky to me.

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One thought on “Jasper and the Beanstalk (Installment 2)

  1. emily says:

    maybe they’re negotiating price?

    the thing that makes me most uncomfortable about y’all being left out of the process is that genentech doesn’t have much reason to feel urgent about it. get paid now, get paid in 6 months, get paid in a year and a half, what’s the difference? though of course on some level they know that there’s an experation date on this kind of treatment, they’re not living with the short person every day — haven’t already lived with the short person every day since he stopped growing.

    non-sequiter:
    the only “possibly related post: (automatically generated)” that’s showing today is one entitled “jasper’s beanstalk.” makes me smile.

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