The Healthcare Saga in Texas

During a routine check-up during my pregnancy in 2019, my doctor informed me that my test results showed some abnormal cells in my body. She said that because I was currently pregnant there wasn’t much we could do then but that I should come back in after Jaxon was born to discuss a health plan to correct it. Jaxon was born in March 2019 via emergency C-Section. It took me quite awhile to fully recover from the surgery. By the time I was feeling well enough to go back to the hospital to talk about the abnormal cells, it was 2020 and all of the hospitals were focused on Covid-19 cases. It would be another year before I finally had a chance to go back to the hospital for a check-up on my abnormal cells. At this point, I was living in Houston, TX and under the medical treatment of a completely different doctor unfamiliar with my health condition. A few days after a regular annual exam, my doctor called me on my cell phone and informed me that my test results had come back with some highly abnormal cells that could become cancerous if not treated. It seemed that in the two years that I had first discovered the abnormal cells, my condition had become worse. My doctor seemed perplexed on why I hadn’t told her about this before. Transparently, I didn’t realize the abnormal cells could get worse and was hoping it would miraculously go away on its own. After all, I seemed fine and really healthy. My doctor told me she was out of the office for a preplanned family vacation but that I should come in to speak to an attending doctor as soon as possible to go over the results and make immediate plans to have surgery to correct it. Jaxon’s dad, Dave, surprisingly volunteered to go to the doctor with me, which I really appreciated since I didn’t have any family in the area. He picked me up the next morning after dropping off our son at school and drove us over to the hospital. He seemed nervous, which wasn’t helpful since he’s never nervous.

The attending doctor was pretty nonchalant about the situation, letting us know that this was a much more common condition than most people realized and that because I caught it early, I had a pretty good chance of stopping the abnormal cells from multiplying via surgery. She gave me a recommendation to a specialist that could perform the surgery and sent us on our way. Dave seemed relieved as we left the hospital, joking “See? you’re not dying. You’re going to be fine.” I let out a nervous chuckle. I hate needles. I hate knives. The thought of having to undergo surgery was giving me anxiety. What if something goes wrong in the surgery? While Dave seemed pretty happy with the outcome of the doctor visit, a nagging feeling told me that the road to recovery wasn’t going to be as easy as the doctor made it out to be. The next day, I make an appointment to see the specialist at the Texas Children’s Pavilion for Women about the surgery. I meet the doctor and he’s fantastic. He’s done this surgery for years and have all had positive outcomes. While I strongly preferred a female doctor, his online reviews showed that women trusted him and referred him to their friends, which is a great endorsement for a doctor performing such a delicate operation that would impact my reproductive organs. We set the surgery for October 6, 2021. My mom books a ticket to fly into Houston so she can help get me home after the surgery and care for me while I recover. I take the week off and it seems like everything is going as planned. Then on September 27, 2021, a week and a half before I’m due to have surgery, the doctor’s office calls me and lets me know that while my insurance covers the surgery, it did not cover the doctor performing it. For us to move forward with the surgery, I could either pay the copay of $10,867.17 out of pocket, or I could get preauthorization and a referral letter from my primary care doctor. I was told the total cost of the surgery was $17,249.48.

Under normal circumstances, it would have been an easy task to get a referral letter from my Primary Care doctor but unfortunately she had literally just left the hospital on September 18 for another facility and therefore could not write me a referral letter since she no longer worked for the hospital I was in. I was devastated and called Blue Cross Blue Shield, my insurance provider, every day trying to figure out a workaround. The gentleman that I reached on the first call, Emmanuel, seemed to understand the gravity of the situation and tried everything possible to get the preauthorization for me. He even gave me his direct line to call him in case something came up. Unfortunately, the billing department would not preauthorize the surgery without the referral letter. I was torn between paying the $11,000 and finding a workaround. On the one hand, this seemed like it could be life and death, and in the grand scheme of things, $11,000 isn’t a lot of money to pay to stay healthy and alive. On the other hand, it seemed really shady that the health insurance covers the surgery and the hospital, but not a doctor in the hospital that has been doing this surgery. It seemed counterintuitive to the purpose of healthcare. When I had gave up hope, I called Emmanuel to vent and to thank him for his help. Emmanuel then tells me he thinks he found a way for me to get the surgery right away for way less than the $11,000 copay. I would need to find a primary care doctor in an office that can also perform the surgery. There was only one facility in Texas that my health insurance covered that met this qualification, and it was the Advanced Women’s Healthcare facility in Dallas. I perked up at this because my sister had just moved to Dallas earlier in the year so I would have a place to stay and recover if needed. I changed my Primary Care doctor to a doctor in the practice, and went to my first primary care check-up. I told the doctor what was going on and she sighed, telling me that I shouldn’t have to go through all of these hoops to get a life-saving surgery but that she understood. She told me to immediately set another appointment for the following week and she would perform the surgery herself.

Emmanuel really did come through for me. The next week I was able to have the surgery in Dallas with the new medical team, who were all female. They were able to eradicate the abnormal cells completely out of my body. What was really crazy about the process was that the new doctor’s office only charged me $250 as my copay! How insane is that! How does a $11,000 copay go down to $250 by simply moving to a different hospital and doctor? The surgery was the exact same one as before. I don’t know what’s going on with the US healthcare system but I am glad God made a way for me to get this surgery at an affordable cost. I am so grateful that God blessed me with the wisdom, discernment, and courage to advocate for myself and try to find alternative solutions versus just accepting the fate that my health insurance provider gave me. I was also thankful for getting Emmanuel on that first call and his help throughout the process. My pastor. Pastor Renelle Johnson, likes to say “You have to participate in your miracle.” The miracle in this case was having a successful surgery at a cost much lower than the quoted $11,000 copay I was told. However, getting to experience this miracle required me to make numerous calls to Blue Cross Blue Shield to find a new solution. I’ve learned that in life we can’t just say prayers, sit back, and wait for God to perform a miracle. We have to do our part and participate in the miracle.