When “place of service” is imaginary

Wes has been prescribed monthly IVIG therapy – an intravenous immunoglobulin-G infusion designed to boost his antibodies, of which he’s in very short supply. Initially they scheduled IVIG to occur on the same day as his monthly LP (“spinal tap”, for which he’s sedated and hooked up) – so one trip, one port access. Worked great, get all his outpatient treatments for the month done at the same time.

The second month we got word our insurance was now refusing to cover IVIG unless it was performed at home, or in a third-party blood clinic. All appeals by the hospital (CHOP) were lost, so we went with home care for the second IVIG – it was scheduled for the day after his LP, so they left his port accessed over night so the home care nurse didn’t have to access him again.

Next week he has third LP, and we were waiting on home care to confirm the IVIG appointment. We just got word that “home care” is now only serving patients at the hospital – but since it’s a different department it still has to be scheduled separately, on a different day.

So instead of doing the IVIG at the same time as the LP, on the same day, during the same appointment, insurance incoherently forced us to split it across two days so “home care” can do the IVIG at home. And now “home care” is no longer visiting homes, so we have to go back to the same facility two days in a row. All because a nameless, faceless, and unaccountable insurance bean-counter has decided that “home care” is better for them.

So two visits; twice as many hours in a hospital; twice the exposure; and for no conceivable cost savings. We aren’t allowed to get his IVIG done at the outpatient clinic, so we have to use home care; but home care is no longer visiting homes, so we have to go to “home care” in the same building as the outpatient clinic, but on a different day since we can’t visit both departments at the same time, and can’t just have oncology do the infusion, even though he’ll already be prepped and on site. So precious nursing resources are wasted and since the hospital won’t allow siblings to tag along anymore because of COVID-19, I have to take two days off work to be with one kid while Stephanie is with another.

Next week now looks like:

• Monday, go to drive-through COVID-19 testing facility to get Wes tested
• Tuesday, go to King of Prussia CHOP while one of us stays home with Ruth. Get accessed, sedated, receive LP and IT-MTX. He should receive IVIG at the same time, since he’s already accessed, and it’d just involve one more bag on his IVIG, but nope: it has to be “home care”. So, leave him accessed overnight.
• Wednesday, go back to King of Prussia CHOP to receive IVIG while one of us stays home with Ruth. Receive the IVIG from a different team called “home care” to satisfy the insurance bean counters, who apparently can’t count.

There’s no way this is cheaper, or a good use of resources even in normal times – let alone in a pandemic. It also increases risk of exposure for everyone.

Kafka couldn’t write something this absurd.