How to Screw Cancer Patients Over Like a BOSS: Tips Gleaned from the Folks at MVP Healthcare

     

How many times have you said this: “Man, I wish there was a quick and easy way to screw over a cancer patient and not pay for services that should be covered!” Well, if you’re an insurance company, you’ve likely uttered this at least 5 million times a day, and you probably have a very precise method for addressing this. But MVP Healthcare may have a better solution!
            MVP is for the first time (unintentionally) revealing its secrets for dicking over cancer patients and aggravating them to the point of insanity, and we think you’ll find it’s very efficient. 

Let’s take a look at how the process works, with one patient we’ll just call Heather, and let’s say she had aggressive breast cancer and is looking for reimbursement for out-of-pocket expenses related to nipple tattooing, a widely recognized final stage of breast reconstruction:

No, not a fan of MVP at this point.

Step 1: Make your company policy known upfront while feigning faux compassion. Example: “Oh Sweetie, I don’t know the specifics of your case, and you haven’t even submitted any paperwork yet, but go ahead and file that claim. They’re not going to pay it.” Cancer patients enjoy being called things like “honey” and “sweetie.” These verbal pats-on-the-head are a sure crowd-pleaser!

Step 2: Don’t bother to say things like, “You needed pre-approval,” because your company’s policy is to deny these claims no matter what the fuck Heather does. This is also the point you ignore all supporting documentation Heather has sent, including a letter of explanation and support from her plastic surgeon and photos of her titties. Holy fuck! Why did this crazy bitch send pictures of her carved-up boobs? Ain’t nobody want to see that shit! Lunch is RUINED!

Step 3: Point out that nipple tattooing by prominent tattoo artists who are known nationally for doing these sorts of things are not covered because they’re not recognized providers. Ignore the fact that hair salon owners are also not recognized providers but insurance companies, including MVP, often cover the cost of the chemo wigs they provide. Roll your eyes if Heather mentions her plastic surgeon doesn’t do tattoos, so she had no other options for completing her reconstruction.

MVP apparently thinks this looks completely normal.
Nope, no tattoos needed here.

Step 4: Speaking of chemo wigs, ignore Heather when she tries to use the example of the time you attempted to deny her coverage for a chemo wig, though her benefits book said you covered 50 percent of the cost, and you tried to deny payment for fat grafting as part of her reconstruction because you viewed it as “cosmetic.” Fuck, don’t these cancer patients ever let ANY shit go?

Step 5: Never give a straight answer. Let’s say Heather calls to check on her claim because she never received anything in the mail acknowledging it but she sees online that it was just denied, with accompanying vague codes mentioning a random code is missing or that she should have only had one nipple done per day. Inform her that, why, you just CAN’T figure out what’s going on and you’re sending her claim back for reprocessing, which should clear things up. Have a good laugh about it when you get off the phone.

Step 6: Play loose with deadlines. Have the first representative tell her that reprocessing her claim should take a couple of weeks, then when that deadline passes, have the next representative tell her that, no, you have 30 days before you have to make a decision. When THAT deadline passes, have a supervisor (let’s call her Sue) tell Heather when she calls back that, “Hey, you were told initially that we weren’t going to pay.” When the patient puts up a fight and mentions what she’s calling a “runaround” (PFFFT! WHATEVER!) tell her you’re on the case and you’ll get back to her with more information on how to proceed. Give her your direct phone line, but –AND THIS IS IMPERATIVE—make sure it’s the wrong number.

I finally feel complete with the tattoos.
But "feeling complete" is not something MVP covers.

Step 7: When Heather calls the next day and points out that the number you gave her directed her to a pre-recorded message, telling her that to go further, she will have to answer some questions and she’ll be entered to win a free cruise, let out a little laugh and make your voice sound apologetic about giving her the wrong number.  Also, make a mental note to bring up with your company’s top brass that you have a great idea for a cancer cruise, which will round up all of the cancer patients and set them adrift on the ocean.

Step 8: Make up more excuses. Something like, “Well, it appears in order to get this claim settled, we have to formally deny it. It was never properly denied.” Heather will mention that there were denial codes attached to her claim and she will ask, “Doesn’t that constitute a formal denial?” This is where you say something super confusing, like, “I would tend to agree with you.” Heather will ask what the fuck that means, but you don’t have to answer. Make it known you’re just the messenger! You should also at this point pretend you still care about Heather’s well-being, and that you want to help her get this claim settled, even though that would mean working against your own company. Maybe she won’t figure it out. 

Step 9: Record a denial of appeal in record time. This will let Heather know how wrong she is—and yeah, go ahead and try to file a level 2 appeal, you dumb shit, Heather. You’ll want to assign a senior medical reviewer for her appeal who is in a totally unrelated field of medicine, say, family practice, and have that person be so fucking dated that he/she could have theoretically been the attending physician at the Battle of Gettysburg. Such a top-notch doctor overrides a practicing plastic surgeon with extensive experience in breast reconstruction and microvascular surgery EVERY TIME.

           

Step 10: If the patient mentions that all stages of reconstruction are covered by the Women’s Health and Cancer Rights Act, stick your fingers in your ears and go, “La la la la – I CAN’T HEAR YOU!”

Just Call Me 'Nip': Virginia Tattoo Parlor is My Breast Reconstruction Finish Line

I'm one of those people who can't make her mind up about anything. Seriously. I will agonize over a restaurant menu like that meal is the friggin' Last Supper. Just fucking pick the wild rice or couscous, Heather.

'Nipple-palooza' was a family affair.

So imagine my anxiety when I find myself seated in Amy Black Tattoo and surrounded by Benjamin Moore-esque pigment samples.  I'd been preparing for this day for months, had conveniently scheduled my nipple tattooing here in Richmond, Va, amid my family's end-of-summer vacation. But somehow I'm still not ready. On the table in front of me are many color choices. Colors that would end up on my breasts. For life. Amy is reiterating that if I'm not sure, I don't have to do this today. The procedures to remove tattooing are costly and time-consuming, she says.

Is this an anxiety attack or hot flash? Beads of sweat are forming on my brow and I may or may not have just tinkled in my pants. (Oh, who the hell am I kidding? I definitely wet my pants. Thanks, hysterectomy.)

Call your husband and get his input, Amy suggests. But he's down the street at the toy store, trying to keep our kids entertained. Her suggestion will involve him dragging our children back -- no small feat -- and you know they'll have their own ideas about the nipples Mommy should get.  No doubt Nora would recommend getting Elmo-shaped headlights, while Fiorello would favor something pirate-themed -- perhaps some spirited Jolly Rogers.

No. Not an option. Right now, the only other member of my family present is my son's hermit crab, Pincher, who came along on our vacation and is sitting calmly in his cage on the floor of the tattoo studio. That son-of-a-bitch is of no help, so I'm on my own.

After much deliberation and some concerned looks from Amy on my indecisiveness, I manage to settle on a color selected from her vast collection of client photos.  She prints out a picture of said nipples, cuts them out, and has me hold them to my chest, trying to gauge my reaction. "That's it, although maybe just a little browner," I say way more confidently than I feel.

Time to get started

I'm fairly certain I won't feel this, given the extent of my DIEP flap procedure -- aka, "the nerve slayer." Heck, you could mistake me for a Holstein and try to milk me, and all I'd feel is some pressure. However, apparently what goes on at the surface is much different than what lies beneath.

Most women don't feel the tattooing. However, I'm not one of them. "Oh yeah, I feel that," I tell Amy as she begins outlining the areolas. She asks me to rate the pain on a scale of 1 to 10, and I place mine somewhere in the area of 6. According to Amy, I'm a rarity who happens to have about 70 to 80 percent of the feeling of someone who hasn't had her boobs chopped off and rebuilt.  Good job, nerves! However, it's nothing that some numbing cream can't take care of.

Getting nipple tattoos is not as orgasmic as I make it look.

Joining me just as the ink starts to flow is my longtime friend from high school, Nicole. Ever the multi-tasker, I managed to find a talented tattoo artist who happens to work out of the same town Nicole now lives in, so I get to see my friend AND get inked. Thankfully, she's not freaked out by the sight of delicate breast tissue getting tattooed and is a willing photographer for this event. (Side note: For the ladies out there considering nipple tattooing, I highly recommend bringing along a friend or someone else close to you for input and support.)

As Amy does her thing, my mind wanders to one of the choices that was easy to make: coming here for this final stage of my reconstruction. A lot of women talk about and opt for "a Vinnie," which is code for tit tats by Vinnie Myers in Maryland. The guy is unbelievably gifted at what he does. But I've seen Amy's name come up in my BRCA groups on Facebook, and for me, something just clicks. She's got a skilled hand and she's launched a nonprofit that helps women pay for post-mastectomy tattooing. I love that. Plus, her studio was recently blessed by some bad-ass Tibetan monks, so I'm feeling pretty confident going into this. It's kind of like my nipples are Dalai Lama-approved or something.

The actual tattooing doesn't take that long, and before I know it, I'm standing in front of a full-length mirror on the wall of the tattoo studio, admiring my new reddish brown nipples. They look way better than the originals, which had transformed into veiny flying saucers following pregnancy and breastfeeding. This was my one opportunity to get the nipples I had always wanted and I ran with it.

That's all, folks!

Whoop! There it is! There's actually a lot of texture and variation
in shading, but my camera sucks so you'll have to use your imagination.

And so came the symbolic end to my breast cancer journey -- at the least the procedural part of it, anyway. On October 2, 2013, I met with my breast surgeon to figure out what the fuck we were going to do about my diseased titties. That had been a Wednesday. By the following Monday, I was meeting with a plastic surgeon to draft a game plan for the painstaking, hourslong surgery required to piece me back together immediately after my double mastectomy.

I had choices in how I wanted to go about certain aspects of treatment - whether I wanted implants or to use my own tissue to recreate the breasts. I was able to choose putting off chemo just long enough to enjoy Christmas that year. But in many ways, I never felt like I had a choice. I did what I had to do. So here I was, finally able to make a choice about the color and texture and shading of my new areolas, and I completely froze up. Guess I was wading into unfamiliar territory. However, I'm beyond thrilled with my nipple results. As I've said before, they're the cherries on top of the mammary sundae. (Bet you'll never look at ice cream the same way again.)

There's still one teensy detail I have to take care of: getting my insurance company to reimburse me the $500 I shelled out. Even though the Women's Health And Cancer Rights Act says, "Hey! Assholes! Cough up the dough for reconstruction," insurance companies still try to find ways out of it.  I'll let you know how I make out. (I'm guessing I'll be using the words "Fucking mother fuckers" a lot.)

The Nipplemorphasis

The night before phase 2 of DIEP flap reconstruction
-- aka, nipple reconstruction and fat grafting.
At this point a wardrobe malfunction for me would mean ...
pretty much nothing. I come self-edited!
(November 2014) 

Sweet holy hell, I look like a calico cat! The bruising is from fat grafting.
This is a few days after phase 2.
(November 2014)

About a week out from phase 2; the nipples were rebuilt
using the "origami technique." Eat your heart out, Martha Stewart!
(November 2014)

Approximately 6 months after phase 2. The one advantage of being
 a pasty Irish mofo is your scars fade nicely.
(May 2015)

Immediately following nipple tattooing. If you stare at them long enough,
they'll start spinning and playing calliope music.
(August 2015)

The final product -- I love my new breasticles!
By a week out from tattooing, I was pretty much all healed.
Anyone know of a local strip club that does
 an "Amateur Stripper/Mastectomy Night?"
(August 2015)

A year down the road: still raising a middle finger to cancer (and the IRS)

Happy Tax Day, everyone!

Just kidding. Fuck the IRS. Those bastards make it damn near impossible to claim healthcare costs on your taxes.

The out-of-pocket expenses for my cancer treatment made a huge dent in my cash flow, but noooooo, it wasn't enough for those sadists at the Internal Revenue Service, who apparently want you to experience catastrophic medical bills before they'll entertain the notion of throwing you a couple of tax-relief bones. So this year, I have the insult-to-injury situation of actually owing the government money.

But seriously, enough about those asshats. I'm ready to celebrate.

Hard to believe, but today marks my chemoversary. Yep, it's been a year since I had the last infusion. Compared to then, I'm feeling a whole lot better obviously. My normal skin color (fishbelly white) has returned and my hair kinda looks like Rod Stewart's now (OK, I don't feel better about that). I still get bouts of fatigue during the day, although it's hard to say whether that's from the lingering effects of chemo or the tamoxifen I'm now on - or maybe a combination of both. (The tamoxifen keeps my body from being able to utilize any remaining estrogen, which fed my tumors, and I'll be on it for at least the next 10 years. Yay.) In any event, it's nowhere near as bad as chemo fatigue.

Yes, what a difference a year makes.

This time last year, I was getting the equivalent of toxic Hudson River water pumped into my veins (that would be chemo) and subjecting myself to needle-stick bruising and the pain of white blood cell boosters. My tear ducts were inflamed, leaving my eyes constantly running and red-rimmed. On most days, me and my Humpty Dumpty head were draped over my recliner like Spanish moss.

Fast forward to this past weekend: I was able to take my son to the American Museum of Natural History's "Night at the Museum" sleepover to celebrate his 6th birthday. At least, it was under the guise of being totally about his birthday. A little part of me also made the reservations as a middle finger to cancer and a celebration of my health slowly returning. None of that "I have to schedule a trip on my 'chemo off-week.'"

From 6 p.m. till midnight, our family and about 450 other people had free rein of the museum. We played tag in the dimly lit halls populated by long-dead animals. I held my son's hand and skipped through the museum's ode to the Pacific Northwest's native people. I screamed along with him as 3-D spiders creepily reached out to us in the movie "Tiny Giants." I smiled at every "That's sooo beautiful, Mommy" as butterflies flitted gracefully around us in the Conservatory. And I sat back, a little teary-eyed, as I watched him speed around the Hayden Planetarium, forcing his scientific knowledge on anyone in earshot, and later, as he sat enthralled by a teenage girl with autism who took the time to tell him everything she knew about space matter. I stared at his little face and the faint smile on his lips as he fell asleep, tucked cozily into his sleeping bag in the Hall of North American Mammals.

Being able to experience these moments, to recapture a little of that lost childlike wonder myself, was truly amazing. And it made all the pain and suffering I had experienced during treatment so unbelievably worth it. I live for these moments.

Whether I have ultimately finished the war with my genetic foe or whether I will have to eventually suit up again for battle remains to be seen. But all I know is, in this moment, I'm alive and I plan on living like I'm alive, making memories cancer can't take from me.

In losing 'the filter' I gained new perspective ... and other really deep, philosophical stuff

You know what's really dangerous about cancer? I mean, besides the fact it can kill you?

It's deactivation of "the filter."

Pray tell, what is the filter? you ask.

Why, it's that part of your brain that keeps you from saying inappropriate or downright crazy stuff. It keeps you from dropping the "F" bomb during a big corporate meeting and from blurting out “OK, so your mouth is moving, but still I find myself not giving a shit" to an acquaintance who is incessantly complaining about rush-hour traffic in whatever overpopulated city he/she lives in.

Admittedly, my filter has always been a little warped. It's the only explanation I have for why I liked to regale people with a play-by-play of the time I got food poisoning from a local Chinese restaurant and stupidly went to bed without a diaper on. But still, I could be counted on to show some restraint...occasionally.

Nowadays, I just blurt stuff out, usually in response to someone being an idiot. It's like I have voluntary Tourette syndrome or something. (See, there I go, probably offending people with Tourette.) So add "ability to silently take bullshit" to the list of cancer casualties. I used to be such a champ at masking my emotions. But I just don't see the world the same way anymore. And when the majority of people haven't had cancer, and don't share the same perspective, that can be an isolating feeling. Ask cancer survivors how being diagnosed changed their lives and they will probably tell you they spent a decent amount of time re-evaluating relationships, careers and everything in between.

Danger, Will Robinson, danger!
She's about to speak!

Now, not every cancer patient will have their filter switch to “off.” There are some people out there who, following such a diagnosis, will still manage to show amazing vocal restraint and spend their free time twirling around in a field of wildflowers like they’re in a goddamn Sting video or something. I am not one of those people.  

In the aftermath of a potentially deadly diagnosis—and amid the reality of a BRCA2 mutation that will dog me for the rest of my days—I’ve come to fully appreciate laughter, my children’s accomplishments and my friends’ milestones. But I have also become steadfast in my belief that most everything else we deal with on a daily basis is self-inflicted or at the very least, in the grand scheme of the universe, not worthy of more than a passing thought. Certainly not the drama-rama people stir up.

As my oncologist pointed out, it’s not really fair to judge how the rest of the world reacts to so-called stressors. Most people have not faced their own mortality and doing so provides you with a much different perspective on life. And I wholeheartedly agree.

I guess I just wish people wouldn't wait for such perspective to come from a cancer diagnosis or other life-altering event.

Meet Heather LaBruna: A cautionary tale for the Angelina Jolies of the world

The following is a piece I wrote for another publication, which didn't use it, so fuck it. I'm publishing it here.

*****

I’ve gone and done it, blown my New Year’s resolution to stop reading the comments on any given news story.

“I'm so scared about dying in a car accident that I'm thinking about removing the tires. Angelina Jolie should go see a psychologist you cannot live in fear of everything.”

 

I dug up that gem—one of the less hostile ones, actually—in the comments section of a  Huffington Post news story about Angelina Jolie’s New York Times op-ed piece. These insults were sprinkled among comments praising the actor, mother and humanitarian for using her celebrity pulpit to spread awareness of hereditary cancer risks. I could probably post a hundred more that criticized her choice, just to prove what D-bags people can be, but I won’t. Because right now I’m pissed.

Had I known about my BRCA status in advance,
I could have taken the necessary steps and likely avoided
this whole baldness mess.

I take such comments personally, not because I have a huge girl crush on Angelina, or because we’re obviously twinsies (cough, cough), but rather, because we’re both mutants. For every Angelina Jolie, there’s someone like me, someone who didn’t know she carried a potentially fatal genetic mutation until after being diagnosed with cancer.

Yes, look at me, world! I’m a cautionary tale!

In 2013, at the age of 36, I went in for a baseline mammogram. I left that warm September day with x-ray images of diseased-looking breasts burned into my brain and the radiologist’s words, “There’s a lot I find suspicious” echoing in my ears. I wanted to tear my boobs from my chest.

Three biopsies later, I learned I had breast cancer. Not just in one breast. Both.  The tumors, while caught early in stages 0 and 1, were grade 3, which, in cancer-speak, means they were aggressive. In addition, there were signs that cancer cells had breached my blood vessel walls and could have escaped into my bloodstream. All this, and I never had a lump or any other symptoms.

A few weeks later came the smoking gun: a positive test for a BRCA mutation. The deaths of my paternal grandmother, my grandmother’s twin sister and my aunt from breast cancer weren’t bad luck. In my family, we had genes that killed. BAM! IN YOUR FACE, every-doctor-who-ever-told-me-that-I had-nothing-to-worry-about-because-the-cancer-was-on-my-father’s-side-and-that-my-breast-cancer-risk-was-probably-the-same-as-the-general-population!

Over the course of a year, I would have a double mastectomy and breast reconstruction using a technique known as Deep Inferior Epigastric Perforator (DIEP) flap, which harvested fat from my abdomen to recreate the breasts. I would also undergo eight rounds of chemotherapy, a hysterectomy and oophorectomy (removal of the uterus and ovaries, respectively), and nipple reconstruction, along with facing down at least 10 years of taking the drug tamoxifen to suppress any residual estrogen production, because my tumors found estrogen DEE-lish. Thanks to the drug regimen and forced menopause, a good day for me means feeling like I’m 70 instead of 90.

So please, don’t think we BRCA mutants take such decision-making lightly. It’s just that the alternative—namely, death by cancer—can be a lot worse. Angelina and I carry mutations in our BRCA genes, she BRCA1 and for me, BRCA2. We all have BRCA genes, which normally produce proteins  that help stop cancer-causing DNA errors. However, for BRCA mutation carriers, these proteins  don’t work properly, making us more susceptible to the Big C.

I remember Angelina taking heat for the first op-ed piece she penned, describing her preventative double mastectomy. But I envy women who are able to reduce their risk of hereditary cancer by being knowledgeable, getting the necessary screenings –and yes, if they choose to, surgeries—to help reduce their risk before cancer ever has the chance to rear its big, fat, ugly head. 

Just how effective is this surgery for preventing breast cancer in women who are at high risk? Try 95 percent or more, according to the National Cancer Institute . You don’t think that statistic haunts me, that had I known about my genetic mutation I might have had the opportunity to reduce my cancer risk drastically? If I had my surgeries preventatively, I’d feel a whole lot better right now about the odds of seeing my two young kids grow up. As for ovary removal, that reduces the risk of ovarian cancer by up to 90 percent and breast cancer risk by 50 percent in high-risk women.

I feel for Angelina and all others who are faced with the choice of removing seemingly healthy parts of their body—the very parts that society so often uses to define womanhood and sensuality. For me and my breasts, things were more cut-and-dry: I had cancer in both of them and they needed to go. But the hysterectomy and oophorectomy?  I was removing my uterus and ovaries based on odds. Though I hated doing it, I never wanted to be facing a cancer recurrence or new cancer and have “coulda, shoulda, woulda’s” filling my head.

Hopefully my journey is winding down, with just my areolas to be tattooed on. My BRCA2 mutation also carries increased risks for pancreatic cancer and skin cancer, to name a few. These risks are nowhere near as high as those for breast cancer and ovarian cancer, but having this knowledge allows me to be vigilant just the same.

So, I just want to say, Ang, GOOD FOR YOU! You were your own advocate and set the course that best suited you—all that any of us can really do, whether we choose surgery or surveillance. Let no one criticize you for your choice. It was yours to make, and yours alone.

And for that HuffPost commenter who used the automobile analogy I referred to earlier, I’m going to break down Angelina’s recent decision for you with another auto analogy, one often used in BRCA circles: If you knew you had a 50/50 shot of your brakes failing, would you continue to drive that car? Or would you do something to fix the friggin’ brakes and keep yourself from dying in a fiery crash?

Yeah, that’s what I thought.