Treatment cost what to expect?

maitcarrie

Hi all,

I am getting treated at Moffitt cancer center.

I already got my port and started the first round of chemo on Friday. Next steps are lumpectomy and radiation.

I have BCBS PPO health insurance. I have not got any big bills yet just copays for office visits

I don’t know where to start. My thoughts were that I will just pay up to my deductible then insurance will cover the rest but this seems doubtful.

Could you please give me any advice on what to do or what to expect?

Thank you very much

DogMomRunner

First piece of advice- do not pay any provider bill unless you have an EOB (explanation of benefit) that matches the bill and it states that this is the amount the patient is liable for.

You will have to pay the entirety of your deductible and possibly your out of pocket maximum for the calendar year. Your company or insurance provider should have someone or a group of someones that can advocate for you if needed.

I had port placement, lumpectomy, chemotherapy and now radiation therapy. And some of the bills haven’t come in yet.

Watch out for balance billing also. If your healthcare provider does not like what your insurance company wants to give them for reimbursement, they will try to make you pay the balance. I initially got a $77,000.00 bill for the lumpectomy. I had paid my deductible and out of pocket max. My insurance advocate negotiated it down to &26,000.00 and sent me a check for that amount and I paid it. I paid it instead of insurance so they wouldn’t try to come back to me again.

Question every bill!!

Brilee76

I have BCBS of SC PPO. I had to meet my deductible before they would pay anything at all. Then, I had to meet my out of pocket max before they would cover at 100%. Your oncologist will need to get pre-authorization for all treatments before BCBS will cover it. BCBS has a website/portal you can log into to see authorization statuses and claims statuses. You'll even see how much BCBS negotiated and paid of the original claim and what your responsibility will be. It also shows how much has been paid toward your deductible and out of pocket max. I don't know what the web address for you would be because I'm in SC and mine is southcarolinablues.com.

MissouriCatLady

I have BCBS and live in Missouri. My yearly out-of-pocket is $3900 (my diagnosis went from 2018 into 2019). I talked to my hospital and am on a payment plan. Best wishes to you - your health is first and most important. There are companies that offer assistance, I had a few Herceptin treatments at a reduced cost. There should be someone in your oncology department that could assist you with this.

keepthefaith

If you are in doubt about the bill/invoice itself, request a copy of it. Years ago, I had a hyst and they charged me for a pregnancy test! LOL. I never had that test. I remembered signing a waiver before SX. So, check the invoice before you start paying anything. They follow a standard protocol and assume everyone gets what they order, but not always so. Also, get a statement if you are paying them monthly. I had a huge discrepancy on my bill/statement and went over it with the hospital billing dept; they issued a refund. If you need financial assistance, ask your financial person at the medical facility. They have grants that can help you pay for deductibles, chemo, etc., if you qualify. You can also contact the American Cancer Society for resources. It's difficult enough navigating appts, nutrition, side effects, etc.; finances should not be a part of this battle. Best wishes to you all!:)

tadover

I'm a state employee. Our insurance is handled by BCBS. First I had to meet my deductible ($1000) before the insurance would pay towards anything. Then insurance paid 80% and I pay 20% copays up to $2500 max out of pocket on copays and $6500 max out of pocket total. Luckily i didn't go much over the $2500 each calendar year I was in treatment. I kept a folder with all my EOBs and copies of my statements from each doctors visits and each treatment I received. Just try to keep everything matched up as you get them. I had one experience of getting a bill that I knew should have been completely covered and had to get a detailed printout of my treatments to figure out what was going on. The hospital had never even filed the claim with my insurance. It just fell through the cracks somehow and got overlooked, but it got my attention when I got the bill for it, lol. It's time consuming, but that's the only way I could keep track of everything. I'm sure your insurance may be a little different amounts for deductible amounts, but just keep good records of everything.

Del13

I have dedicated a bank card, just for this cancer care, I pay all copays,bills,and meds, I match up the dr bill, ins billing with bank statement, use the card for any and all expenses I have, so much easier for me,

gb2115

It's the deductible, and then usually a percent of everything else....for me it's 20%. I had to pay my out of pocket maximum, twice, because I was diagnosed in October and didn't finish radiation until February. Surgery got me to the $3000 the first time, then radiation got me to the $3000 max really quickly after the new year.

maitcarrie

Not sure if replying this way replies to all. Those who mentioned your deductibles and out-of-pockets maxes- they seem way lower than mine. (deductible: $7,500 Out-pock-max: 15,000). Must be time to upgrade to a higher premium with lower out-of-pocket max? I am also starting treatment in October and will have to restart in the new year. I also have not done any of the pre-authorizations so far so this should be fun! Thanks for your responses!!

maitcarrie

Not sure if replying this way replies to all. Those who mentioned your deductibles and out-of-pockets maxes- they seem way lower than mine. (deductible: $7,500 Out-pock-max: 15,000). Must be time to upgrade to a higher premium with lower out-of-pocket max? I am also starting treatment in October and will have to restart in the new year. I also have not done any of the pre-authorizations so far so this should be fun! Thanks for your responses!!

OnTarget

I have BCBS, my BMX alone was $75k, plus a ton of other appointments and tests.

I paid my Out Of Pocket Max and that's it.

MountainMia

Yeah, OnTarget. All my bills for the year aren't processed yet (diagnosed in February) but it looked like between lumpectomy, chemo, and radiation, it would add up to at least $200,000. I think this underestimates, but I don't know how much, truthfully. A BIG pile of money. I paid my out-of-pocket maximum of $3500, which I hit by mid-April, and everything else has been covered. My hospital does all the pre-approval work, all the processing. I haven't touched a bill since about 5 months ago. I have BCBS in Iowa. My premium for the year was about $7200, and it will go up to $8000 or something like that for 2020. It's private insurance, not from the exchange or from an employer. Finally I'm getting my money's worth...

Castigame

Maitcarrie,

I went to Moffitt for BMX and chemo and I still go there for checkups and scans. You are in the best hands. Yes I was in your shoes. My surgeon , Dr Kiluk cut me really good my scars the cleaniest I have seen from other bc sisters. my MO, Dr LOftus did the absolute best. I am alive that is the only thing natters. I had $3000 ded and $11000 out of pocket max w diff health insurance company. My total bill was $11000 which was OOP for the year. I was dxd right after Xmas and was able to squeeze all surgeries and chemos and scans within the next calendar year. I still have balance to pay but Moffitt uses company called Acessone to whom I pay $25 per month w about 9% it would take about 15 yrs w current balance alone but it is worth it.

With that all previous posts are

good advices. If your OOP is $15000, unfortunately you will be getting the entire $15000 bill this year I know it is easy for me to say please do not delay any treatment.

However because you treatment schedule you are likely to be hit w OOP again for next year. For this reason I really don't think changing insurance may be worth it unless it is the same company and additional premium should be lower than OOP difference.

For 2020, if your body can tolerate check everything, GYN check ups, colonoscopy and optional surgeries. And heart checkups is a must after chemo is done.

Please please take care of yourself.

Also let us know how you are doing.

pingpong1953

$77,000. for a lumpectomy? Are you kidding??? Please tell me that's a typo.

canadaliz

Sisters, My heart breaks when I read about women worrying about how to pay medical bills. I am Canadian and have never seen a medical bill. In America you are under a stranglehold by insurance and drug companies and the result sickens me. So much misinformation is spread by them to make you fear universal healthcare. To set the record straight we do not have people dying in the street, nor the death panels often spouted by Republicans, nor wait times so long people die, nor 'socialist medicine'. When the #1 cause of bankruptcy in the USA is medical bill related and, according to the WHO a child has a better chance of reaching age 5 in Croatia than America due to access to healthcare you need to rethink your system. Spoken by a member of a successful social democracy--superior healthcare should not be reserved for the rich and no price should be placed on the health of any American. For the life of me I don't know why you aren't burning buses in the street and demanding that your tax dollar be spent on the medical health of Americans before sending aid to third world countries. I know this doesn't answer your original question but it might persuade you to vote for a candidate that supports healthcare for all. As the only first world nation without universal healthcare and one of the wealthiest nations on the planet it is a moral disgrace that women, or indeed any person in the grip of illness, must worry about how to pay a medical bill. There is a better way--universal healthcare.

flashlight

There has to be a better way than Universal Healthcare. None of our politicians would give up their private health insurance! People come to the US from all over the world to receive our healthcare. This isn't a political forum. Here is what another Canadian had to say in another post.

Got a call-back for another mammogram and an ultrasound which is on Friday. Haven't felt well for awhile. And I don't like the "slowness" of the Canadian health-care system. Only reason I have the ultrasound on Friday is that they just had a cancellation before I called. Not knowing is frightening. I hope I don't have to wait for months to find out what's going on.

exbrnxgrl

canadaliz,

I am in complete agreement! I have watched people have to declare bankruptcy due to medical bills, cut pills in half or skip doses of expensive prescription meds. Our ER’s spend fortunes on caring for sick folks who should have been treated earlier but had no medical insurance. It is criminal that we let this happen in the US. I am stage IV and though doing well enough to work full time, a big motivation to keep working is the great health insurance that I have.

Flashlight,

We are one of a few, maybe only, first world countries without some form of universal health care. Though not perfect, no one needs to become destitute just to pay for medical care. Personally, I have no problem with longer waits if a situation is not urgent. Yes, people do come from all over the world to use our health system, if... they can afford it. My point being that decent healthcare should not be a privilege for only the wealthy or those who have good private insurance. Again, there are many models all over the world for some form of universal healthcare. We should be able to figure something out. Nothing will be perfect and fit every need in every situation ( as anyone even with health insurance can tell you!), but I’d love to see the day when all Americans have access to health care.

Re: political forum? No, this is not, however we have many, many threads about non-bc topics. There are two specifically political threads, but they do not appear on active topics.

Anonymous

Im an American receiving care on the NHS in the UK for this and its like I cant opt out of the system. Or I haven't figured out how to yet at any rate, even though I have good private medical coverage. Its mixed feelings - glad I don't have to worry about bills but the time pressure these doctors are under makes me very, very nervous - all the way from my GP up to the breast specialists/surgeons. They will throw me in a scanner for just about anything, and I appreciate what this must have cost, but I've also been to four different hospitals now all over London for various scans and tests and doctors and its exhausting. Some of these hospitals aren't that nice either, to the point where I've worried about cleanliness and germs.

I've finally made it to the apex, though, and the hospital is very nice, specialized, the services more streamlined, and the MOs feel less rushed. It will be good to get started, but it also took almost 6 weeks to get to this point, where otherwise you read on here of some posters getting diagnosed and into surgery/chemo in three weeks. Sure its only an extra three weeks, but when you don't feel well and all these scary tests are happening and you don't feel like you have a grasp as to the system and who is in charge of what, its daunting.

Some sort of proper hybrid system would be best, I think, but not to the point where the Universal option is starved completely to the benefit of the private options.

Sara536

As a Medicare patient, I paid very little in copays for doctor visits, surgery, radiation, medications, etc.

The Democratic candidates for the next USA President (as of October 15) have just started to debate the idea of “Medicare for all". ...let them know how you feel.

gb2115

I am happy with my health insurance (a commercial plan that covers a lot), and although I have an out of pocket maximum of $4000 ((used to be 3000), I appreciate that if something bad happens I won't have to pay more than that. My tamoxifen is free too which is nice. I have friends with high deductible plans that have low premiums but if they get super sick they are screwed.

I don't know about Medicare. I work in the medical field and see literally every day patients who's medically necessary medications are unaffordable under the "good" part D plans. Like over $1000/month for a 30 day fill. Can't give a pharmacy coupon to a Medicare patient. So they go unmedicated. If this is what Medicare for all is, we need a better way.

Sara536

gb2115, When I said, “let them know how you feel” I meant either way. They need to hear about real experiences. They are not doing a very good job of explaining their ideas on the subject and they certainly don’t all agree with each other. Also, I should not have included the drug plan in my comment. I just happen to be taking very inexpensive drugs at this time but I would be in big trouble if I had to buy the really expensive ones. Thank you for reminding me!

flashlight

This turned out to be a interesting topic with interesting views. With Medicare you have to have A, B and D. After you work years paying into the system and if you are lucky you will get about $1300. a month in social security. After taxes, Medicare part B is subtracted, about $135.00. You now have to be in some kind of part D plan for drugs which has a deductible around $400.00, but plans can vary between $25 to $120.00 a month. Then you have to think about a supplemental because Medicare only pays 80%. You see those Medicare Advantage commercials on TV and they range from 0 to $300. a month. What if your doctor or Hospital is in a different state and you don't want to change then Medigap plans come in at a higher rate starting around $150.00. What about vision, dental, and co payments. What if the supplemental won't cover the remaining 20%? It is very confusing.

edwards750

There are political forums on this website. One in particular is as one-sided as you can possibly get. The link is not labeled a political forum but that’s exactly what it is. All the ladies are on the same side like it’s their own personal space to voice their opinions and dare anyone to disagree so if you venture over there be prepared.

Diane

canadaliz

Hi, Where would I find it? Cheers, Liz

exbrnxgrl

edwards750,

Please note that cross posting on the political forums i.e. liberals posting on the conservative forum and vice a versa is not allowed by the moderators. They intentionally made it “one sided" as things were getting too heated prior to that. This was their decision in order to keep the peace and, from my perspective, has worked.

Canadaliz,

I am only familiar with one of the political threads. You can pm me

ShetlandPony

To address the OP's question about what to expect, my advice is to budget to pay your out-of-pocket maximum so you won't be caught off guard. It could turn out to be less; that is, your deductible plus a percentage of the rest. But also, be prepared for the non-insurance expenses: Lost work time for both patient and caregiver, extra take-out food and a house cleaner because you lack time and energy, self-care products you didn't need before (lubricating eye drops, vaginal moisturizer, lotion lotion lotion, dry mouth rinse, wigs, caps, makeup), transportation to all the appointments, providers or products not covered by insurance.

Hb4hikes3

hi, how did you get reduced costs for treatments of herceptin

bkerber

Can anyone give me insight as to how radiation and chemo are billed? Since they are administered in the facility where my doctors are, is it considered a specialist visit or something else?

Yogatyme

They probably have their own procedure codes and the facility should bill for you.

DogMomRunner

pingpong - yep $77,000 for a lumpectomy.

canadaliz- I would love Universal Healthcare. Especially if we focused on nutrition and prevention.

gb2115

For radiation, the hospital billed I think for bundles of treatment, maybe 5 at a time, can't really remember. It was expensive, got me to my out of pocket maximum by the end of January. I was thankful for the maximum limit.