Cancer Part 2: The Insuring

It’s been a few days since my diagnosis and my hospital—who I cannot name due to libel laws in the UAE—is dropping the ball. I was waiting for approval for a blood test. Let me give you a quick timeline.

• d-day: “Hello, what is the status of this blood test?”
• • Insurance: “We are waiting for your hospital to provide us with additional information.”
• *Hospital: “We will call you back.”
• d+1: “Hello, what is the status of this blood test?”
• • Hospital: “We will call you back.”
• d+2: “Hello, what is the status of the blood test?”
• • Hospital: “Oh yes, I see we were supposed to call you back. I am escalating your request.”

It is now d+4 and the hospital has yet to call me back. At d+1 I could already tell where this was going. As I mentioned in my blog, this wasn’t my first rodeo. Essentially I had two options: be a good boy and wait, or shop around different hospitals.

I did the latter. Because I’m a cheap bastard, I opted for a comprehensive plan that has hospitals with decent reviews. Decent, but not good. The highly rated Cleveland Clinic, for example, was out of my plan, so unless I wanted to pay American rates for treatment, this wasn’t really a good option. It feels weird typing this. I seem to value my savings more than my health. It’s funny how that works. That perhaps is not the right mindset, but that’s not the point of this post.

I found a few hospitals that got somewhat favorable reviews on Reddit. I take reviews online with a grain of salt. Especially reviews on Reddit. But generally, you can tell what the sentiment is by gathering enough information.

And so by the end of d+1, I reached out to Hospital B who emailed me back within 2 hours, asking for my contact details, which I gave. Not expecting much—after all, the bar has been set so low already—I was called back on the morning of d+2 asking whether I could come in in about 2 hours. That was a pleasant surprise. Yes, most definitely I can come in.

When I arrived, the nurse seemed already aware of my case. I brought with me a lab report and ultrasound report, which they asked if they could copy. I have tons of copies so I told them to keep it, and that if they wanted more copies, I would gladly provide them with such. The nurses then took my vitals, my weight and my height, and I was sent to the doctor’s office for the consult.

The doctor at Hospital B is not as renowned as the doctor at Hospital A. But he did something that the doctor at Hospital A did not: he listened to me. “OK,” he said. “Let me see what is up.” For the umpteenth time, I had a sonar pressed against my throat. Like last time, the doctor found the tumors. “Do you see this?” he asked. I was reminded of the last time a doctor asked me this. “Yes, I can.” “OK, do you see the shape of it?” Yes, I can. “So this shape is not a good shape. It’s jagged. And do you see the white spots? That’s calcification. It means the tumor has been there for a while. But, it looks like it’s not growing. Or if it is, very slow.” “Here we have your lymph node. Can you see it?” Yes. “This white tissue here is different from the one on your nodule. Here, we want to see white tissue, but you can see it’s less.”

The nurse cleaned my neck and, like at Hospital A, the doctor asked me to take place in front of his desk. “Brian, this is very early stage cancer.” “I can tell you are anxious, so let me tell you: thyroid cancer tends not to spread. It contains itself in the thyroid. The lymph nodes, it’s not good, but we can take them out. It’s not a thing I have not seen before.”

“So, what’s next?” I asked. “We will schedule you for a biopsy. We cannot do today, but Wednesday should be no problem.” At Hospital A I had to wait 3 weeks, and after 3 weeks of waiting the radiologist told me he could not do it because he wanted to do a punch biopsy. I explained what Hospital A wanted to do. He explained to me what the procedure would be like. Three needle pricks to take samples. We aspirate the tissue. Suck it up, place it under a microscope. Sounds easy enough. But nothing I hadn’t heard before. “And before you go, please scan this QR code.” He pointed to a QR code that was on his nameplate on his desk. “It’s my contact details. Anytime—you can email or WhatsApp.” That’s new. If I wanted to contact the doctor at Hospital A I would have to go through a service desk. I shook hands with the doctor, and with perhaps a misplaced sense of hope, I left his room.

The nurse asked me to come to her office. She explained I did not have to take any precautions before coming this Wednesday, the 26th. However, if Hospital A scheduled a biopsy too, my insurance would probably decline the biopsy at Hospital B. I had to cancel the pre-authorization. That should be no problem, I thought. The nurse said she would call me by the end of the day to ask whether I was able to cancel the pre-authorization. My heart sank to my shoes. I am sure they would call me back, but today? I have yet to see it happen.

My insurer has Sundays off, so I could not cancel. I played with Thomas—as much as babies can play—made dinner for my wife, and went about my Sunday as I had done many times in the past. Until my phone rang. It was Hospital B. “Hello Brian, how are you? Were you able to cancel?” “No, not yet.” “OK no problem, I will call you again tomorrow! And in the meantime I will submit our request anyway, OK?”

The next morning I called my insurer right away. “Sir, we don’t see anything for a biopsy at Hospital A, only a blood test. But we do see a request from Hospital B, which was approved this morning.” What the fuck? Hospital A never even submitted a request for a biopsy yet?

I was as angry with Hospital A as I was relieved with Hospital B. I dropped by a good friend before driving to Dubai, when Hospital B called me. “Hi Brian? It looks like the insurer approved our request. Were you able to cancel?” I had to explain I could not cancel something that did not exist. “I’m so sorry about that, Mr. Brian, but you’re all good for Wednesday!” Some good news, finally. So now, on Wednesday they will biopsy my thyroid. The doctor explained that this was to determine how much to cut. He explained there are three options:

1. If there is no cancerous tissue detected surrounding the nodule, they might be able to microwave away just the nodule.
2. If there is cancerous tissue detected surrounding the nodule, they will remove the right lobe.
3. If the lymph node is cancerous too, they will remove my entire thyroid plus the offending lymph nodes in that region.

I had no options at Hospital A. And suddenly Hospital B is talking about options. What a difference. Between night and day. Anyway, I now have to prepare to get my neck stabbed with fine needles, once again. But this time, I have no questions about what is going to happen. Hospital B briefed me well, and told me what to expect before, during, and after the FNAC. That is more than Hospital A ever gave me.

I originally titled this blog post “Fight for Yourself.” But I ended up talking more about my insurance than actually fighting for yourself. But the message stays the same. Only one person in this world is always looking out for you: and that’s you. You cannot reasonably expect anyone else to do this job for you. This means that if your gut tells you something is not right: trust your gut. I would rather apologize to Hospital A for rushing them than to apologize to myself for allowing a shitty situation to become even worse.

The squeaky wheel gets the grease.

Stay squeaky. Stay greasy.