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

Julia -

I'm so sorry you've been going through all this.  Could you not just get a skin-sparing mastectomy for now and do reconstruction later - perhaps when you get better insurance or more money saved?  Cancer advocacy groups advertise in the Cancer magazines some of the oncologists carry in their offices.  Have you talked to your surgeon's insurance person to see if they can steer you toward a place where you could get some assistance?  Also, contact the Susan G. Koman foundation - they're supposed to be there for the underinsured too.

Keep the faith, Julia!

Let's not make this a healthcare/insurance issue (what's not available and should be, what Crunchy should have/have not done...) but find a solution for Crunchy.  About a year ago I researched some programs for a woman in Georgia -- seems like the gov't has some good ones.  Crunchy -- get the social worker at your hospital working for you and see if there's some financial aid for you.  It is ridiculous to ask someone to cough up several thousand dollars up front -- it isn't realistic for most.  Perhaps the financial department at the hospital can set up a payment plan.  If you have do, dump the cost on a credit card for now and then get a bank loan at a much lower rate to pay it off.  No matter what, get the best treatment that is recommended for your particular situation.  Hang in there Crunchy -- it will get sorted out.  Hugs,

Elizabeth

I'm sorry you are having such difficulty.  somebody said "pay the minimum $1/mo or whatever"  that is an option and one that is perfectly legit 

As for "Obamacare"  I've lived in both systems, the European Socialised Medicine system, where for non urgent matters, you have to wait, and the US healthcare system, where you still have to wait!  I don't have the luxury of healthcare through an employer, we pay our own healthcare - for our family of 4, it costs us $1,600/mo of our own $..... for an HMO!  Each year, it increases.  When we took this policy in 2003, we were paying $550/mo  we're now stuck into this plan, my dh had a heart attack and now I'm facing whatever I'm facing!  Give me socialised medicine anyday, I'll sneeze into my sleeve.

Crunchy - I am so happy to hear that you are looking at all your options and making the best decision for YOU!   I know exactly where you were emotionally when you started this tread since I had the same knee jerk reaction when I went in for my treatment on Jan 4th and was advised of the provisional changes from co-pay to 20% co-insurance...I FREAKED OUT!  Once I had calmed down and reviewed the policy terms again (I was in chemo when the re-enrollment came out...can I blame chemo brain?) I was able to make better decisions and it looks like you are on your way well.

Amy - thank you for posting about the difference in the HMO co-pay vs co-insurance with max out of pocket...I would have actually SAVED money last year on this plan because I was seeing a Dr. 2-3 times a week for treatments for four months (chemo/PS/BS/PT)  and the co-pays alone were $75 - $125 a week - that was after I met deductible and out of pocket maximum.     

Hugs!

  That a girl, now you are thinking the right way. I will take a big glass of that lemonade you are making.

     We have a  $350 deductible, $5,500 out of pocket maximum and believe me, it was not hard to hit it at all last year what with all the scans, tests and chemo...reached it by April.   I took out a new credit card with a o% interest rate for the first 6 months...didn't get it paid off in 6 months, but just kept putting anything extra I had on it and by Dec. 30 had it paid off.  My onco's office figures out what you have to pay each month, but they were understanding if I sometimes paid less. Once we hit it, I had no office copays with any of my doctors or Rxs and squeezed in everything I could, including new scans in by Dec.31, so they were covered. I even asked them to do a cell search and a few other things that I knew were expensive tests.  Now it's another year with another deductible and max out of pocket to meet, but the good side of that is I am still here.  I hate cancer and I hate having to deal with bills and insurance, but it beats the alternative.  I will keep you in my prayers. 

Julia, Definately second or third the idea of immediately contacting the hospital (or whatever) social worker. And get to your local social services office if you can. Lastly, they cannot get blood out of a turnip-if you feel you need the surgery, try to go for it! Prayers with you. SV

I have to jump in here! IF you medical costs for the year exceed 7.5% of your income, you can claim them on your taxes. Not sure how to figure out how much you get back but itemize your costs (including what you are paying for the health insurance premiums) and see what you come up with. You can also claim travel, mileage, tolls and parking.  I keep records of everything as my MDs are 100 mi round trip and it is usually $8 to park.

I, last yr, had $1500 ded and $3500 out of pocket. The $1500 was included in the $3500; it was not an additional charge.

Crunchy, I'm telling you the best way to wade through all of this mess is to call your insurance company and ask for an oncology case manager. Or a regular case manager, as they are RNs and can help you slog thru all of this. And they should know about community resources. Here in MA we have a medicaid plan called CommonHealth that you can purchase cheaply, even as a secondary insurance. Or so it used to be. The laws change so much who the heck can keep pace with them.

At one of the local medical centers here , they have a "prompt pay discount." Hey, any money in my pocket is better than in theirs! I called the hospitals in Boston where I was treated and they have no such thing. But it never hurts to ask. 

Good luck with all of this and your treatment, Sue 

I'm sort of in the same boat....I was diagnosed Nov. 6, 2009.  I had two surgeries in November and quickly met our deductible and just about had met our out-of-pocket.  I had to have a bilateral, and was hoping to get that in before the end of the calendar year....ah, but it didn't happen.  The operating rooms were already booked up.  So, when did it get scheduled???  January 6th!!!!  Just in time to start the new year off.

$1000 deductible....$3500 out-of-pocket, and we still have to pay our co-pays!!  So, each month I pay a little bit to each medical group.  And yes, the hospital DID call the day before my surgery telling me what was going to be our part, and yes, the hospital DID ask me the day of my surgery if I brought in my payment.....and NO, I did not bring in anything....and YES, I continue to make monthly payments.....and no, they are not charging me interest on all of this.

I have a son in college and a daughter who will be going to college in a little over a year, so money is tight, to say the least.  (and I have a 12 y.o., too!) My getting cancer was not in the plan (duh..obviously!), and this certainly was not good timing to say the least....

But, I have found in the past (when my daughter was born nearly four months early, staying three months in the NICU, and we had a ton of medical bills back then!!) that if you make faithful payments to a medical goup/facility, they won't bother you...and sometimes, they'll even write off a little bit toward the end    The key is to be faithful - never late, and always, always, always pay what you can! 

(p.s.  and I understand about husband's work insurance policies...my husband didn't have an option this year either.....it's expensive on our part, and our benefits are only so-so, but it's better than nothing!!)

Good luck!!