Insurance, White Blood Cells, and Advocating for Your Health

Good morning from the twilight hours - those quiet moments before dawn when the world is still and thoughts run deep.

I'm sitting here wondering if I'll be going to see my oncologist today for a shot of Neulasta, a medication I desperately need but almost couldn't get. It's a story about insurance barriers, the absurd cost of healthcare, and why having proof that you're sick enough matters more than preventing you from getting that sick in the first place.

Let me explain.

What is Neulasta?

Neulasta (pegfilgrastim) is a medication that stimulates the growth of neutrophils - a type of white blood cell crucial for fighting infections. After chemotherapy destroys both cancer cells and healthy white blood cells, Neulasta helps the body produce new neutrophils faster, reducing the risk of dangerous infections during treatment.

Without enough neutrophils, your immune system can't function properly. A simple cold could become life-threatening. A minor cut could lead to sepsis. Cancer patients die not from the cancer itself, but from infections their devastated immune systems can't fight off.

So Neulasta is, quite literally, life-saving medication for many chemo patients.

The Insurance Catch-22

Here's where it gets frustrating: at first, my insurance wouldn't cover this medication.

Why? Because there was no proof that I would need it.

Let that sink in. My body was about to undergo aggressive chemotherapy known to destroy white blood cells. The research is clear about what chemotherapy does to neutrophil counts. But until my specific white blood cells actually dropped to dangerous levels, insurance wouldn't approve preventive treatment.

It's a medical Catch-22: we can't give you the medication to prevent a dangerous condition until you develop that dangerous condition and prove you need it.

Getting the "Proof" Insurance Required

At my oncology visit yesterday, the blood work showed what we all knew would happen: my white blood cell counts are continuing to drop.

Now we have proof. Now insurance will approve it.

I'm grateful the approval came through. I'm grateful my oncologist is monitoring my counts closely and caught the drop before I developed an infection. I'm grateful I'll get the medication I need.

But I'm also frustrated by a system that requires patients to get sicker before approving medication that could prevent them from getting that sick in the first place.

The Sticker Price: $7,000 Per Shot

When I researched why insurance was so hesitant to pre-approve Neulasta, I understood their motivation immediately: the sticker price for just one shot of this medication is almost $7,000.

Seven. Thousand. Dollars.

For one injection.

And I'll need many of them - one after each chemotherapy infusion.

I am so grateful I have medical insurance. Without it, I'd need to be a billionaire to afford cancer treatment. The medication alone would cost tens of thousands of dollars, never mind the chemotherapy drugs themselves, the scans, the hospital visits, the biopsies, the surgeon fees.

The math is staggering. The inequality is crushing. Not everyone has insurance. Not everyone gets approved. Not everyone survives because of it.

Why This Matters Beyond My Story

I'm one of the lucky ones. My insurance, after requiring proof, approved the medication. I have access to the care I need.

But this experience has opened my eyes to how many people don't get approved. How many can't afford the co-pays even with insurance. How many fall through the cracks of our healthcare system because the barriers to care are designed to say "no" until you can prove you're sick enough.

How many people get infections that could have been prevented if they'd been given Neulasta proactively instead of reactively?

The system isn't designed to keep people healthy. It's designed to minimize costs until sickness is undeniable.

A Note About TennCare

If you're in Tennessee and don't have health insurance, please know this: You can apply for TennCare, Tennessee's Medicaid program, any time of year. There isn't a specific open enrollment period like there is for the Health Insurance Marketplace.

You can apply online through TennCare Connect.

I'm not saying TennCare is perfect - it has its own barriers and limitations. But it's better than nothing. And nothing means you can't afford treatment when something goes wrong.

Please don't wait until you're sick to figure out your insurance situation. The time to apply is now, while you're healthy enough to navigate the paperwork.

Your Annual Checkup Reminder

While I'm here talking about healthcare access, let me be that annoying friend who reminds you: when was your last annual checkup?

I know, I know. You feel fine. You're busy. You don't like doctors. It's expensive even with insurance.

But here's what I've learned: I felt fine too, until I didn't. I ignored symptoms for two years because I thought it was just depression or hormones or stress. By the time we found the cancer, it was stage 3B bulky - advanced disease that had been growing unchecked.

What if we'd caught it earlier? What if I'd advocated for better testing when the medications weren't working? What if someone had ordered a chest X-ray a year sooner?

I can't change my timeline, but you can still shape yours.

Make Sure You're Taking Care of Yourself

This is your reminder to schedule your annual checkup if you haven't already.

Get your bloodwork done. Do the screenings your doctor recommends. Don't ignore persistent symptoms that aren't resolving.

Advocate for yourself. If something feels wrong and no one is listening, keep pushing. Get second opinions. Request additional tests.

Your life might depend on it.

Mine almost did.

The Twilight Hours

I'm still sitting here in these quiet morning hours, grateful for insurance that eventually approved what I need, aware of the fragility of that access, thinking about everyone who isn't as fortunate.

By the time you read this, I'll probably know whether I'm getting that $7,000 shot today. Either way, I'm still here. Still fighting. Still advocating - for myself and for anyone else navigating this impossible system.

Take care of yourself and your body. It's the only one you get.

Love you all.

💜 Kayla