March 2014 Surgery

Lakegirl1

KLJ...that is better than my Onco type getting denied.   Something about no evidence of hormone therapy, blah blah blah...

Genomic Health is working on the appeal. 

Serioisluy!?!!?!?!?

linda505

LOL KLJ - now that is the craziest thing I have heard AETNA do!!!  Was it from Aetna themselves or that company that they hired to do their approvals and denials.  I get letters from them everyweek when they have approved or denied something except not for prescriptions.  I wanted a letter when they denied two different mouth sore meds - ended up not needing them yet - but really wanted to see the reason.  Well at least with that crazy reason you know it should be easy to get fixed!!  Thank God they are required to send out that written reason.

scubalady

Aetna denied the claim from for my UMX anesthia stating that it had reached the limit for payment for that service.  My insurance year started April 1 and my surgery, was April 16.  Guess I was supposed to have my surgery with a shot of whiskey and a stick in my mouth to bite on for the pain.

Aetna admitted that the claim was processed wrong and are re processing the claim.

ucfmom

Aetna was my biggest nightmare and work headache last year.  I'm a benefits coordinator for my firm and we had Aetna as our insurance provider last year - for one year only, thank heavens.  Everything that could possibly go wrong with enrollment, did.  It was seriously an administrative nightmare.  And I'm not even talking about claims processing, they couldn't get anything right.  When the first batch of ID cards came out, there were mistakes on the majority of them.  They had incorrect birthdates, incorrect addresses, misspelled names, missing dependents, etc.  They sent the second batch of IDs out and they were all still wrong!  It was the same thing over and over for months.  I think I was still fighting with them in June and our plan year started January 1.  We're back with UHC this year and I hope to never have to deal with Aetna again.

KLJ

Linda505, this was directly form Aetna! It's completely laughable. Can't wait to get on the phone with them tomorrow. I still need to go through and make a spreadsheet of what has been billed, paid, applied to deductible and so forth. When I log into our Aetna account it still shows that our deductible hasn't been met. So confusing! I'm on it though. I will figure this out if it's the last thing I do and Aetna WILL be paying! I'm kinda bull headed that way LOL!

sandra4611

So sorry to hear of all the trouble with insurance approval. That has to be so stressful. I can't imagine having to go through it when you are trying to do everything possible to save your life! It's just cruel. This is one time that being a military dependent has worked in my favor. We may not be able to get second opinions or have much of a choice about how fast things are done, but at least there is no worry about insurance approval. Routine appointments are a pain in the neck to get, but if you are really sick, they take good care of you at my hospital.

I've gained so much weight in 18 months since I had a stroke and had to quit work and quit teaching fitness classes. I put on about 20 pounds in the first 8 months and now 12 more pounds since my BMX in August. When you aren't teaching 6-8 Zumba & Pilates classes a week, but you keep on eating like you did before, the pounds add up. Now I'm a roly-poly but since my June surgery got postponed until September, I might as well try to get some of this weight off. Having to give up my accounting career, my fitness career, and stop teaching ballroom dance - all at the same time after the stroke - was so hard. Then I got diagnosed with an aneurysm in the ascending aorta of my heart. A few months later the breast cancer was found. I've had four surgeries and still am not finished yet because of the damage caused by the awful infection I had after the BMX. I found myself doing this:

 

Time to make a change.

 

KLJ

Sandra, my daughter's breast cancer treatment was completely covered by Tri Care. No questions asked. She was so fortunate to have them. And, she didn't even have Army doctors. The doctor in charge of breast cancer pts. was on vacation so she was referred out to civilian doctors which were very, very good! It's always good to hear GOOD insurance stories!

SpecialK

klj - I have Tricare as well and all of my care except for echocardiograms has been by civilian providers. All I pay is a nominal co-pay. Our base facilities do not include oncology or surgery departments so I am referred out to network providers. One of the reasons I was able to participate in an out-of-town clinical trial for Her2+ is because my treatment costs were so low. I did have BRCA testing because I am adopted with no family medical history info, but my understanding  is that Tricare no longer covers this, even with a BC diagnosis. They refused payment for Mammoprint, they consider it "experimental" even though it is FDA approved, but since I didn't  sign anything saying I would be responsible I did not pay for it either. I was refused for a colonoscopy ordered by my MO ( I had one 5 years earlier) because they said I didn't fit the risk profile for a screening one. Seems like breast cancer and 25 skin cancers would buy me that ticket. They did say if I had any symptoms they would cover it, but that seemed a bit late to me. My onc said he could get it covered but I decided to leave it alone, and maybe do it later.

KLJ

SpecialK, my daughter was fortunate enough to get the BRCA test done and covered by Tri Care. She was diagnosed in 2011 so I think this is before they stopped covering it. She never even had co-pays. Everything was covered completely. I think we paid up front for her wigs and then got a slight reimbursement for them. But it was fantastic coverage. I wish I could say I was having the same luck with Aetna!

sandra4611

We are fortunate to live in San Antonio which has the largest military hospital in the country. In addition to our Tricare for Life premium (which isn't much compared to civilian insurance plans) we pay a small amount for every day we are hospitalized. It's supposed to be to cover food and is $17 a day I think. Then if we can't get into a specialty clinic like physical therapy, Tricare sends authorization to one of the civilian providers on their list and we have a co-pay of $12 per visit. The big ticket item is when you leave the hospital, but have a visiting nurse, lab tests, and meds. After all 4 surgeries, I left the hospital each time with a PICC line and had to pay for continued IV vancomycin (our cost was $900 a week for at least two weeks each time) plus the cost of the nurse visits every other day and the civilian lab costs to process my blood tests every third dose of vanc. In the end, it cost us more than someone with civilian insurance would have paid with their deductible. All these out of pocket costs are what's left over AFTER Tricare pays their 80%.  Still, I'm thankful for excellent treatment in a top-notch facility with doctors who don't have to worry about insurance approval.

DiveCat

scubalady, I can't believe they were going to deny you anaesthesia! That is ridiculous!

I am Canadian and don't have to pay one iota for my healthcare (prescriptions are another matter, but I do have insurance for that through work along with dental, and extended expenses like massage and physio). It does have its own flaws, like sometimes a longer wait for elective procedures or specialist referrals, but I never take my universal healthcare for granted after reading some of these stories. I remember being particularly grateful after reading stories of other women getting prophylactic surgeries (like me) having to appeal their insurance companies to approve the surgery at all, or having to battle over approving Alloderm, etc.

iwannaseeyoubebrave

I haven't written anything in awhile.  I guess there's no excitement going on with my fills, which is a good thing. I've been hanging out reading and staying up to date the best i can.  I'm excited to announce that I now have my exchange date set for August 13th!  That date can't come soon enough.  I held some implants today at the PS office and it was heavenly.  Can wait!

jbdayton

iwanna congrats on an exchange date.  Hope everything goes just as you want. 

Juliecc

Congrats, Iwannaseeyoubebrave!  I'll be a few days ahead of you on 8/8.

KLJ

Congrats to both Iwannaseeyoubebrave and Juliecc! I'm about a month after you!

iwannaseeyoubebrave

Yay Julie and KLJ! Moving forward!

Blueberry4

Tricare paid for my BRCA test and oncotype test in March. They also preapproved the mammoprint test in case the oncotype was in that medium range. It wasn't.  I have tricare prime and my husband is active duty. I wonder if that made a difference?  I have felt so lucky to have everything covered 100% all at private facilities since we don't have a base clinic or hospital within the designated distance.  I have had to get some waivers and special approvals, but they have all gone through within a couple of days.

I haven't posted over here in a while, but have been reading.  I'm so glad so many of you are moving forward with fills, exchanges, life.  I'm in chemo land, but will eventually get to join you in reconstruction land .  

jbdayton

Patience Blueberry, I know exactly how hard to wait is.  I am at 17 months now and still have many months to go.  The longer this goes on the weaker the body gets and the slower the healing.

I would still not change anything I did.  Cancer free after surgery.

Prayers to get through chemo.  Hope rads are not in your future.  Keep trudging along and the end will eventually be in sight. HUGS!!

SpecialK

blueberry - I have Tricare Prime also, don't think the active duty piece has any bearing - they covered a massive amount of chemo, Herceptin, and a boatload of surgery without batting an eye.  The Mammaprint test was not being covered by Tricare in 2010 when I had it. It received approval from the FDA in '07 and it is possible Tricare was not yet ready to give approval without more data showing usefulness.  I think there was enough flack when they discontinued BRCA that they reinstated it. It was covered for me in 2010, then discontinued, but maybe now reinstated?

Ally2345

Yea!!  More August "Exchange" Sisters...I have my exchange set for August 11th.   It seems so far away at times but I know it will be here before I realize it.  I have my PS pre-op meeting on the 22nd of July so between now and then, just letting these darn TEs do their job.  

Ally

KLJ

Congratulations Ally!

Kitty62

Haven't posted in a long time, but have been peeking in from time to time. I got my last fill (topped off at 500cc) a few weeks ago. Don't see my PS til 9/9 for my pre-exchange visit. He said he would be doing my exchange some time near Dec...I am hoping more like  Nov. Am not sure what happened to my foobies, but am lopsided now. One is very noticeably higher than than other. Frankly I could care less if someone notices. He said he can even them out so that's what I'm banking on. It's been quite the roller coaster ride for us ladies. I held onto this group like a crutch on those tough months. For that I am deeply grateful. I tear up writing this and thinking about how hard it was. On the other hand,  I know I was very very fortunate in not needing Chemo. God bless you ladies that have had to endure the "full meal deal."  Have a great day!

SpecialK

So happy for all of you getting your exchange dates and being able to see the light at the end of the tunnel.  My tunnel has been a bit longer than most - will be looking at an expander in September, and another exchange at some point - maybe the end of the year.  Not sure.  Its all good though - I will get there.

kitty - "full meal deal" made me laugh!

sandra4611

Such sweet words, Kitty. Let us know how it's going as you progress along this crappy journey. These threads seem like the only bright spot some days.

Kitty62

Special K...you are special with a capital S. Hell...all caps!! Lol Seriously, you have been such a wealth of knowledge ans support. Thank you! Glad you got a kick out of my "full meal deal" comment. You, my dear, have gone thru THEE "seven course meal"...and then some. Hoping you get to a much deserved and delicious dessert

Sandra...you started this group and also have been a wealth of knowledge. Thank you! This BC journey alone is a tough one, but what you've endured healthwise would have totally kicked my ass. My hats off to you for still being positive and upbeat. You are an inspiration. 

Frostecat

Ditto to what Kitty posted!

linda505

good morning march sisters.  Just had my last fill!! woo hoo - now just need to wait until beginning of Oct for exchange.  Still need to finish chemo but at least part of my journey is done.  Hope everyone else is doing great

Juliecc

Congrats, Linda!  Another milestone achieved!

linda505

Thanks Julie - does feel good to have one thing finished!!  Such a journey we are all on - btw I have to post what I wore on my head for my appt today

Frostecat

Haha Linda - I bet the Dr's office looks forward to seeing you come in!  Did you have the tassles on too???