Insurance Problem

Alcarroll

Hello Everybody,

I'm hoping someone has some information on the wonderful topic of health insurance. I received a letter yesterday that states the facility where I am receiving treatment (Cleveland Clinic, Weston, Florida) will only be accepting ONE insurance through the Health Insurance Marketplace. Yikes, only one selection was my first thought. I looked at the various plans offered and there is a place to enter the doctors and prescriptions that you are currently taking and they tell you what each plan covers. To my shock, not ONE of the plans offered all three of my medications. I am taking Letrozole - that's covered, but the Lupron (to stop ovulation as I am pre-menopausal) and the Xgeva are not. Ummm, what now? I know Lupron is used with IVF procedures. Maybe for cancer treatment they will allow it? From the explanation of benefits for the past few months that I've been receiving the injections, it looks like the Lupron runs around $2,300 month. The Xgeva isn't cheap either, in the hundreds, for each shot.

So what is a person supposed to do? Change treatment centers? Hate to do that as first PET scan had "extensive bone mets, moderate to intensely avid FDG sites" but next scan showed "no FDG uptake" in bones and decrease in primary tumor and effected lymph nodes. I'm comfortable with my doctor and feel like what's she's doing is working.

Undergo surgery for ovary removal so Lupron not necessary? Rather not have surgical procedure when everything is going along well. Don't fix it if it ain't broke, I guess.

Try for Social Security Benefits or Disability? I don't know anything about either of those things so don't even know if that would even help. I'm working my regular job...trying to work as much as possible to save up some money to put my husband and daughter is best situation, financially, that I can.

I'm proofreading and I'm afraid I sound like a real complainer! I am a positive person and really don't believe this disease is going to get me any time soon...but I gotta have my medicine if I'm going to give this cancer-bitch a run for her money!

Any information on this girls?

pajim

Alcarroll, I can't help with the insurance, but you can replace the Xgeva with Zometa. It's an infusion rather than a shot but is about 1/5 the cost and more likely to be covered. And as you said, you can replace the Lupron with an oophorectomy. (both of these things have been shown to be equivalent) If one of the plans covers 2 out of 3. . .

You might also check the main part of this site where they have tips on how to pay for treatment. Often drug companies will help with co-pay cards and the like.

Next suggestion -- there has to be someone at your center who deals with this sort of thing. A social worker or navigator or something. They see this all the time and know much better than any of us who covers what for whom.

For disability and medicare you would need to leave your job. You go on short term disability then long-term disability which usually pays 60-70% of your current salary. With that you can apply for Medicare but there's a wait. I do NOT know the specific details on this so do NOT take my word on this one. There's a thread in the "employment and insurance" forum where a lawyer spent a lot of time explaining all of this. If you wish to go that route, you should read it.

It sounds like your treatment is working well. This disease is not going to get you any time soon.

Cafelovr

It really upsets me to read stories like this. The government has no right to interfere with a doctor's diagnosis and treatment of a patient. I looked at my medical bills from the last 7 years...1.575 million dollars in treatment. I can't afford copays, deductibles, etc. I have to clue...bankruptcy? It's like we're being punished for working full time. Maybe we should milk the system. Ugh! I would check into Medicare/Medicaid...

I'm a Zometa girl myself. I took Lupron before I decided to have a hysterectomy. I wasn't planning on having kids anymore...just take it out so there's one less medicine to take. I wish you all the luck in the world!

sharethehope

Dear cafelovr ur not milking the system when u have paid into these programs 4 yrs.. U have a right to the assistance & I believe anyone who needs it should try & try again if necessary to get the help necessary. Pajim has some very good advise Alcarrol fight 4 what u need if u have to. Good luck & let us know how everything goes.  Apil

Fitztwins

Try to find an insurance advocate. I have one and she knows the ins/out.

Call your oncology office and your insurance provider, they may help you navigate this better.

As to medicare, you have to be on disability for 2 years to qualify. Also, I had my ovaries removed vaginally and it was a very easy surgery and recovery. Some doctors do it out patient. I have not regrets getting it done.

LuAnnH

their is a website called www.patientadvocate.org, they offer assistance in various fields.  Maybe someone can help you in their organization.

Wiegp22

so how do you pay these bill