Gov. Abbott and Lt. Gov. Patrick: Nine-year-old Kensley caught in the TRS conundrum

            July 2, after midnight, I wrote a new blog post because I couldn’t sleep due to anxiety over a thyroid sonogram I had later that morning and the overwhelming out-of-pocket expenses I am now facing courtesy of Gov. Greg Abbott, Lt. Gov. Dan Patrick, most members of the Texas Senate, and several members of the Texas House.  You see, like my fellow Texas Retired Teachers’ Association retirees--which includes teachers, bus drivers, custodians, classroom aides, librarians, nurses, maintenance workers, police officers, secretaries, and administrators--I am living the TRS nightmare.

            At 7:16 p.m. that same day, one of my friends tagged me on a Facebook post by a woman named Megan.  I contacted Megan after reading the post to get details about HER TRS-healthcare nightmare.  (It isn’t only TRS retirees living this healthcare nightmare.  MANY active members are living it, too.) 

            This is what I learned:  Megan works for Dickinson ISD.  She first worked as a “paraprofessional” (I have always despised that word.) but has been a certified teacher in the district since March of 2000.  She is a current teacher on TRS Active Care 2 – Select.  Last school year, she was also on Active Care 2 – Select; however, she was living in Galveston County, so she had an “open network option.”  This school year, she was told she has just one option, KelseyCare Aetna.

            Her KelseyCare Aetna plan started September 1.  Megan’s nine-year-old daughter, Kensley, had been under the care of a pediatrician and a pediatric endocrinologist; however, Kensley’s doctors were not on the KelseyCare Aetna plan, so Megan had to find new doctors.  She made an appointment with a new pediatrician September 1 to establish Kensley as a patient.  Immediately, this new doctor referred Kensley to Texas Children’s Hospital for further testing.  Not so fast, according to KelseyCare Aetna.  It took Megan over a month, and countless phone calls, to get the approval to make an appointment at TCH.  It took another month for the paperwork to make its way from KelseyCare Aetna to TCH.

            So although Kensley’s doctor referred her to TCH September 1, her first appointment with an endocrinologist at TCH wasn’t until November 16.  Any parent would agree that waiting two months for an appointment a pediatrician said should be made ASAP is a nightmare.  But according to Megan, that was but a small taste of the nightmare she, Kensley, and their entire family have been living since.

            The November 16 appointment involved drawing labs.  Kensley was scheduled for a thyroid biopsy November 21.  While Megan should have been calming the nerves of her little girl the day of the biopsy, she instead had to spend over three hours on the phone, still awaiting approval.  That approval was finally granted just 30 minutes before the scheduled biopsy. 

            The results revealed that nine-year-old Kensley had thyroid cancer, which required her to have a complete thyroidectomy in December.  She also had to have one of her parathyroid glands removed, and her surgeon took 14 lymph nodes to check for metastasis.

            After the surgery, KelseyCare Aetna informed Megan that there wasn’t enough documentation to substantiate the removal of Kensley’s thyroid.  In fact, they denied coverage for the tumor removal three times, claiming it was not medically necessary, while approving chemotherapy, which was not even an option presented by the doctors at TCH.  After more hours on the phone, away from her daughter, and unimaginable stress, the surgery was covered.

            Then Megan was told the lab work done November 16, which cost over $1000, was not covered because Megan used Quest Diagnostics.  They claim the plan Megan and her family are on through Dickinson ISD only allows for LabCorp.  Megan used Quest Diagnostics because she got on the TRS website even while at TCH that day, and the website clearly displayed that the TRS Active Care 2-Select paid 100% if the member used Quest.  However, now KelseyCare Aetna is busy playing the blame game.  They blamed Megan for choosing the wrong lab.  When she told them she had screen shots to prove what she saw on the TRS website, they blamed her district for sharing the wrong information, TRS for posting incorrect information on their site, and even the state.  Megan is still fighting this.

            Just this week, Kensley had to return to TCH for a full day of tests, including five x-rays, and the addition of two prescriptions and two over-the-counter medications. 

            (TCH tried diligently to help Megan by applying for a “Medicaid buy-in,” which would allow her to keep her insurance but pay the government an additional insurance premium for secondary coverage.  The application was denied because Kensley’s cancer had not spread.  Kudos to them.)

            This week’s tests showed no new tumors in Kensley’s thoracic cavity, which is the best news her family has heard since September.  They know their little girl faces a lifetime of body scans, ultrasounds, lab work, 3-9 pills a day, radioactive iodine therapy, lymph-node mapping, and more.  She continues to endure aches and pains, weight gain, thinning hair, and bald spots.  She already has appointments at TCH scheduled for July and August, as well as an ultrasound, oncology appointments, labs, infusions, and more medications scheduled for September.

            Megan and her family need to focus on precious Kensley’s recovery.  Instead, Megan is spending hours on the phone and enduring untold anxiety over denied medical bills because she is a Texas teacher caught in the 2017 Texas Legislative Session’s TRS conundrum.

            Meanwhile, in Austin, Gov. Abbott has refused to even acknowledge the calls for a Special Session to address the TRS healthcare nightmare.  Who can possibly explain what public school employees and retirees across this state ever did to deserve his disdain?
            So I ask again, Gov. Abbott, Lt. Gov. Patrick, and members of the Texas Legislature, while this mother, a TEXAS TEACHER, can’t sleep because of the worry over her little girl diagnosed with cancer and constant battles over insurance coverage--or lack thereof--HOW CAN YOU SLEEP?

These are screen shots Megan took from the TRS website before choosing to use Quest Diagnostics back in November

   

The message Megan received just this week from a representative at KelseyCare Aetna regarding the NOVEMBER lab work:

Chris Ardis retired in May of 2013 following a 29-year teaching career. She now helps companies with business communications and social media and works as a sales coordinator for Tony Roma's and Macaroni Grill. Chris can be reached at cardis1022@aol.com.