Insurance

labpsb

I think this is an overwhelming overlooked very important piece of the cancer treatment puzzle.   What insurances pay for what?  Who gets delayed or denied? Are cutting edge treatments covered?   How to get permanent disability?  When can you get Medicare?  Is it good or bad to transfer to Medicare?    HMO....PPO....Medicare.....Gap..... Prescriptions......Now what with Obama and health care?  Is the government going to start limiting treatment based on how long you have lived because they are going broke?

Maybe I am just in the wrong forum for this question?

People on Medicare?

There does not seem to be a good place to post this, Moderator please move to proper forum if needed...

I need some input from people on Medicare... although my wife is only 50 on 08/01 she gets Medicare A & B, an insurance friend came over and signed her up for AARPs California F and a prescription plan.

He claimed it was the Cadillac of plans minimal out of pocket and she can go anywhere.

We currently have Kaiser and for the past two years they have done a very good job, Lynne is stage 4 IBC Triple Negative.  She is currently on Avastin and Xeloda (This is the 1^st chemo combo out of many that is working!). 

She is nervous about leaving Kaiser; my plan was to take her to MD Anderson for a complete evaluation and treatment course (spending what ever time we need to in Houston).  I would be happy to hear from people who have gone to Anderson also people that are using an insurance plan I outlined (Medicare A B plus AARPs gap and prescription).  Any problems paying for treatment??, chemo??? As you know Avastin and Xeloda are very expensive and Lynne may be on them indefinitely.

I have to cement this new direction or can it and keep her with Kaiser, I have about 60 days.

Thank you very much   Paul and   Lynne

makingway

Paul and Lynne,

You need to find out exactly where you're wife will be going. Act as if you already have Medicare make appts, or try to. Only then will you see how few physicains accept it, and the quality of care you get. I'm not on Medicare, but am familiar with MediCal. It's very hard to find a doctor that will accept it. Apparently they reimburse less than $0.10 for every $1.00.

Here's a link to contracted hospitals for the Medi-Cal program.You must use these hospitals if you are in the program. I'm not sure about how Medicare works. http://www.dhcs.ca.gov/provgovpart/Pages/HospitalContracts.aspx

Get the "Formulary list" of drugs Medicare covers to see if the mdeciation your wife needs are included in it. I thought I had a link to it,but can't find it now...

Good Luck-Knowledge Is King!

labpsb

Hello and thanks for the reply, we will not qualify for MediCal, some states call it Medicaid and others call it Access.  Our income is to high, so if I go that direction Lynne will have Medicare A B plus AARPs supplement plan F and AARPs prescription plan.  I do plan to talk to the billing dept at various centers, but there must be thousands with the exact plan I was setting for Lynne.  I am hoping some would weigh in with the good or the bad.

Thank you very much

Paul

PS Lynne had her Avastin and Xeloda again yesterday her oncologist said she will be on them until they stop working.  He also set her foe a new round of scans.

1Cathi

Paul I just read your post, I hope I do not offend you or your wonderful wife, just a suggestion that if perhaps you go to the forum "Older Woman with Breast Cancer" some of the ladies there with experience with Medicare and AARP might be of great assistance, they may not have seen the post here.

BEST WISHES.

labpsb

Hello Cathi

I will explore that thread, I did talk to MD Anderson and City of Hope today.  Both of them claim they fully accept the Medicare and AARPs gap (hospital and doctors) and they say I should have no out of pocket (or less then I have now with Kaiser).  I just want to make sure we don't get blindsided.

Thanks Paul