Welp, crappy insurance = no mastectomy for me... can't afford it

Wow - this is an eye-opener for someone NOT in the US - to be denied potentially life saving surgery because of craptacular insurance is terrifying. Is there any chance you can find an alternative more reasonable surgeon? Or Plan B - is there an oncology-type intervention that could minimise the chance of the DCIS changing/spreading - your onc score says hormonally responsive - has any dr suggested adjuvant meds - such as tamox or an AI + or - an ovarian suppressant if required??? I cannot believe they would just let this go - and you with it!!!!

Fidelia

This is just not right.  The same thing happened to a friend of mine she had no insurance so she died.  I was so angry and this is in the good ole USA.  Contact the all the cancer society's in your area.  Get it done and make payments.  It will be a lot more expensive if it spreads.  There has got to be a way.  Maybe a teaching hospital.  Ask oncologist and everyone you know where to get help.  Please don't give up.  Keep contacting people, keep fighting until you get what you need to get well and healthy.  All the money we donate there should be a budget set aside for people like you.  Hang in there.

Julia -- your health is the most important thing.  No matter what, do what you need to do.  Even if you end up making monthy payments of $1, $25, or whatever you can handle.  Take care of yourself first.  Everything else is secondary.  More hugs,

Elizabeth

xox

Just wondering how this is an "Obamacare nightmare" when no health insurance related legislation has been enacted. 

I don't know if any of this will help but here is what I know of.....The state where you live may have grants available through their medicaid program that may cover all fees at the hospital.  Your doctors may accept what the insurance will pay and write the rest off if you explain the situation to them.  They all do some work pro bono and this is not even the case here, at least they are going to get some payment from the insurance.  The 1998 Mastectomy Act requires that if you are part of a group health plan then the insurance carrier can not deny the surgery or reconstruction so at least you know that they will cover a percentage over your 1300 deductible.  For any bills applied to your deductible set up a payment plan with everyone.  Ten bucks a month is all that you have to give.  If your hospital is not private then they should also know of grants and aid programs.  There are ways to do this....believe me people that have zero insurance work it out everyday.  I work for a state agency keep asking questions and requesting options, there are usually lots of programs that people do not even know of.  You may have some issues if the doctor does not make it clear that the mastectomy is clearly the necessary step over lumpectomy and hormonals.  Insurance companies like to take the path of least resistance.  I had cancer in both breasts so I had no other option than BMX.  I trult understand the desire to have a baby and having this be a big part of your treatment decisions.  When I went on chemo I went on Lupron to "protect" my ovaries so that DH and I could try to conceive in a few years.  We had tried for about three years to conceive with zero success.  We had all tests done and both were frustratingly normal in that department.  I even went on Clomid to make sure I ovulated. Nada.  Anyway Lupron was a waste of time because my BC was invasive in both breasts so I had to go on Tamox.  As luck would have it the test for Tamox showed that I was a poor metabolizer. I had to have my ovaries out immediately and had to go on an AI. Being young with invasive cancer it was just too risky to go without.  No biological children now, ever.  Crushed did not begin to describe how I felt.  Now we are starting adoption and, for us, this feels right.  I hope that you get your heart's desire and you are blessed with a little angel.  This journey can be at times completely frustrating and miserable and this sounds like one of those moments for you and I hope that things work out for you and you find the way to get this surgery and piece of mind.  The advice to call the cancer organizations is great as well because they usually have patient advocates that can direct you to finance options.  Good luck with all of this.  Don't give up on this because your health is too important and you need to be around for that little person in your future.

Since there is no public option there is nothing to "mimic". And corporations, federally funded or not, are all trying to cut back on health insurance for employees (some simply discontinue that benefit, which they are are entirely free to do) because of the cost. 

What state are you in? Usually there are special programs for breast cancer within the state health department. Oklahoma (where I am) has SoonerCare - and that is absolutely no co-payment.The only problem might be if you have too high of an income.

 I hope you get everything taken care of. I pray for you.

Please contact the Livestrong organization and sign up for their Survivor Care program, they will set you up with an intake counselor for the Patient Advocate Foundation, who very well may be able to help you with your out of pocket expenses.  Can't say I agree with the Obamacare comment either, if we had good reform here these situations would not exist.  My husband's company is owned by a staunch Republican who chooses the plan, we have no options.  Our deductible was $750 in 2006.  It is now $5000 per person and I have no reason to believe it will not be $10,000 in a few years.  The one thing I have learned in the last few years is that we have to be our own advocates, most of the doctors do not "get it" when we talk about struggling with medical debt.  I completely organized my own biopsy last Nov., no help from my surgeon at all, (I think he is now my ex-surgeon, unless he wants to operate on my tonsils)  I had a suspicious MRI in August, he wanted to follow it with complete diagnostics every three months, mammo, mri, ultrasound.  Once all the bills came in on the August testings, I knew there was no way we could afford to follow his plan and start all over on a new $5000 deductible in 2010, therefore I took the matter in my own hands, found a facility in Nashville, ordered all my own tests to be sent down etc.  My bill for an MRI guided biopsy?  $0.

You are new to this and honestly, at the stage you are at now, I would not have been at all prepared to take on my doctors, but I am telling you it is something you are going to have to learn to do.  Your health is more important and you need to follow your initial treatment plan as closely as possible so that if the cancer ever comes back, you will know in your heart that you did everything you could the first time, that it is out of your control.  Do you have a loved one, friends or a church group that would advocate for you so that you can just focus on getting better?  A friend of my daughter was diagnosed at the age of 30 and had poor insurance, even though she works for a hospital.  Her friends staged a fundraiser at a local restaurant, and even though it is a very small town, they raised over $17,000 towards her out of pocket expenses. Its all very frightening, frustrating and overwhelming, but you need to take the steps to get this done.  You will be in my thoughts and prayers.  

Hi Julia! So sorry about the insurance situation. I feel your pain and anger. Have you tried an appeal to your insurance? I had to appeal several times and even contacted the Insurance Commissioner of the state. After appeals they covered everything. It was a pain in the booty, but it's worth a shot! Good luck!!!

((((((gentle hugs)))))))

First of all people please slow your roll and stop yelling at someone who is venting - even if you dont agree - is it that important to be right in anonymous online forum of all places?

Crunchy, please try to separate the issues - what does your doctor recommend you do - are you comfortable with that or do you need a 2nd opinion?

Second, insurance - can you have the surgeries done at a hospital with surgeons that ACCEPT your insurance - there should only be approved copays in that case. If you have out of pocket costs - are they capped at a yearly or lifetime amount? Please call the social worker at your doctor or hospital and find out what your options are.

You know your health is more important than cost - so please find a way to make it work.

Good luck!

It sounds like your plan is a HDHP (high deductible health plan). Many companies are going to these- they have a high deductible but then once the deductible and out of pocket max is reached, they pay everything at 100%. I had a plan like this when I was dx last year. The surgery reached my maximum immediately and then there was NO MORE CHARGES for ANYTHING for my radiation, herceptin, etc etc etc.  Yes the 3000 deductible (that is what mine was) is a lot, but they are doing these to be able to keep the monthly premiums low(er).  I have been thrilled with my coverage. It is changing now (Cobra ran out) and I wish I could have kept it.  Am going with a state run program that is similar but not quite as good. Monthly premium is LOW though. You just have to prepare for the out of pocket  costs.  There is usually an HSA component to this type of plan. HSA=Heath Savings Account. This is a way you can deduct pre-tax monies from your pay to fund the account (sometimes employers will match) and you get a debit card to access that money. It is to be used to pay the deductibles and out of pocket amounts.

I know this may be oversimplifying things and may not be exactly what you have. BUT i wanted you (and others on this thread) to know that the HDHP is NOT a bad plan, or 'crappy insurance' - it is a different way of doing things.  When we had the orientation to the various plans offered, they did different scenarios and the HDHP worked out better than a traditional health plan EVERY TIME.  One of the reasons is that with a traditional plan, the copay NEVER goes away, so if you see a lot of drs, it keeps dinging you over and over again, whereas with the HDHP, once you hit your max, it pays 100%.

I hope this is the way yours is. If so, once you hit the max, you will have NO more medical bills for the rest of the year. It was a huge relief for me.  And also, I think the hospital or doctor (or both) should be able to acccept a payment plan for your part of the surgery. They are going to get most of the reimbursement from the insurance company (because you will have used up your out of pocket max by the time surgery is done.)
Good luck. I hope this works out.

Amy

CPM, what seemed to slow you down last year was trying to coordinate two surgeons. Without reconstruction you don't really need a plastic surgeon, just a general surgeon. One doc, one pay.

Good luck!