insurance and finances

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cookiegal
cookiegal Member Posts: 3,296
insurance and finances

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  • cookiegal
    cookiegal Member Posts: 3,296
    edited November 2009

    It's too bad this has to be a topic, but I think it would make a useful forum.

  • Moderators
    Moderators Member Posts: 25,912
    edited November 2009
    It is a good idea. Thanks, we'll discuss!

  • cookiegal
    cookiegal Member Posts: 3,296
    edited November 2009

    thanks for the reply...I realize there is a risk it could become political and that is not my intention.

    However those of us battling insurance and cancer could use a little extra support!

  • germangal
    germangal Member Posts: 97
    edited January 2010

    PLEASE!! I found information about qualifying for SSDI on the Stage IV board --- and now I found a discussion regarding life insurance benefits that I knew nothing about. And, I had a question about accessing 401K funds ... it would be really, really beneficial to have a forum dedicated to financial issues we all face!  BTW, there was an article in weekend WSJ regarding foundations to help with copays associated with CA treatments; I  don't know where to post the link ...

  • bonnie1jean
    bonnie1jean Member Posts: 40
    edited February 2010

    It is a disgrace that we should have to be burdened with financial and insurance issues at a time when all we should have to be dealing with is getting well.  I really think there should be a forum added here regarding this issue.  I was diagnosed December '09 with DCIS and have not even decided on a treatment plan yet, but today I added up all of my incurred out of pocket expenses since diagnosis and it is over $6,000 and I do have insurance.  I find this mind boggling.

  • 2z54
    2z54 Member Posts: 261
    edited February 2010

    I totally agree that insurance and finances are major bc issues and concerns that should have a forum. I'm 55 and currently on COBRA since losing my job in Novemember.  I don't know how I'll get insurance, let alone "affordable" insurance when COBRA runs out.  Vote me in to this forum!   And it needn't be political as long as those women who think fixing our broken health care systems means we're all Socialists or Communists, stay away!

  • GryffinSong
    GryffinSong Member Posts: 439
    edited February 2010

    Finances are such a huge issue, count me in for discussion. I have insurance, but if it weren't for my mom's help I'd never have covered the deductibles without tapping into my 401k. And now I'm contemplating whether to do some reconstruction or at least fix up the lumpy areas, and I don't know what the financial burden will be. It's really tough. I have a friend who has it even worse, because she is stage III and does not have insurance. She worries about everything.

  • amyob
    amyob Member Posts: 99
    edited February 2010

    I also have an insurance nightmare to share.  My company covers reconstruction, but could not find me a PS who did "immediate" reconstruction and was "in network" at the time of my surgery.  I had my hopes dashed to bits by my company too many times to mention while I was awaiting surgery, trying to deal with my cancer diagnosis!  I found a PS who's staff assured me, "We would work it out with the insurance."  A day before my surgery was scheduled, the staff called to inform me that the insurance would not pay unless the Dr. signed up for the plan (which he refused to do).  They told me I needed to pay $5000 upfront.  I decided I did not want to wait for reconstruction and I would fight it out with the insurance later.  I went ahead and gave them my credit card number but, before I did so, I asked if they would reimburse me if I was able to work it out with the insurance.  They said, "Of course."  After filing many complaints and a grievance, the insurance ultimately told me they could not pay the Dr. without a claim.  My PS office refused to file a claim since I had already paid them "self pay".  I begged them to simply submit a bill and reminded them of the fact that I had been assured from the beginning that we would work this out and that I would be reimbursed.  They apologized for the "misunderstanding" and said they would not submit a claim.  What a system!!       

  • bonnie1jean
    bonnie1jean Member Posts: 40
    edited February 2010

    Amyob:

    They are obligated to submit a claim for you or give you a bill with the diagnosis code, procedure code and amount charged.  I work in a doctor's office and most of our patients are self-pay and I give them a paid bill with the above information so that they can submit it to their insurance carrier.  Maybe a threat of reporting them to the local county medical society might light a fire under them.

  • amyob
    amyob Member Posts: 99
    edited February 2010

    Thanks for the great advice.  A forum is a great idea!  I'm not sure there's any hope for me, though.  My insurance is Anthem HIP (Healthy Indiana Plan), which is partially funded by medicaid.  It's supposed to help people who can't afford the high costs of insurance.  You send them your income papers and they decide how much you can afford.  Then, they help you pay the rest.  Sounds great, right?  Well, the catch is that the Drs. you go to MUST have a medicaid number in order to be paid.  Although there was NO Dr. in my area that had a medicaid number, and the state law requires reconstruction, state law does not apply because medicaid is federally funded.  Money mouth   

  • Hoolianama0508
    Hoolianama0508 Member Posts: 162
    edited February 2010

    It sure does stink when finances and insurance are added to our list of concerns besides fighting for our lives. I was diagnosed with breast cancer while unemployed which meant no insurance coverage. I applied and qualified for a medically needy program in my state of Florida but with a share of cost. This is when they decide on your income, or lack thereof, what they feel you can afford each month before they will cover the rest.

     In the beginning, I was so stressed about the entire process of billing and self pay. I would go to my chemotherapy sessions worrying about meeting my share of cost for the month. I distinctly remember drifting off to the benadryl drip, thinking about all the medical bills.

  • amyob
    amyob Member Posts: 99
    edited February 2010

    I'm so sorry to hear about your troubles...  It should be against the law to do this to people Frown  The law of morality!!

  • cherneski
    cherneski Member Posts: 726
    edited February 2010

    Hello Ladies, I thought I would let you all know a little about what I have learned.

    I was laid off my job in November and was paying COBRA.  Well the company (my old job) closed, thus leaving no insurance policy no Cobra.  The scariest part of that is that I got the letter that my insurance had been canceled effective January 29, on February 17th.  Yes you read that right I got the notice 2 1/2 weeks after I no longer had insurance.  It is completely legal what they did.  

    The notice from insurance has all sorts of information about HIPPA and to make sure I do not go 63 days with out coverage otherwise it will be considered a break in coverage.  What they dont tell you is if you go 31 days without coverage they are allowed to consider my pre-existing condition.  This is all NJ laws.  Each state is different.

    My advice to EVERYONE is to call your state insurance commissioners office and get familiar with what the laws in your state are.  If you are on Cobra, I would call every 28 days to make sure the coverage is still effective, because they can cancel you retroactive and it will still be legal.

    Luckily for me, I found out just in the nick of time.  I now have a private policy for just me $407.99 per month.  My kids and husband have nothing right now.  Kids will be able to get state insurance, but DH is beat, as we make too much money with us both collecting unemployment.  

    Good luck to you all, Lord knows we need it.

    PS my Drs get paid about 10-20 bucks a month, they are all very cool with that, they know I have bills to pay, and prescriptions to fill.  As long as I make an effort they are happy.  If I miss a co pay they dont give me greif.

  • cherneski
    cherneski Member Posts: 726
    edited February 2010

    Bonnie, If I were you I would get a better policy.  I am amazed at the cost out of pocket to you already.  Are you including the cost of the insurance policy too?  I really do think you can get better coverage, that is absurd! 

  • blondie45
    blondie45 Member Posts: 580
    edited February 2010

    Okay, here is/are my problems.

    I had unilateral mastectomy in April 2009. I wanted bilateral. The day before surgery insurance company said no as the left side was "not diseased."  I was not about to stop removing the right side with disease the day before so I went ahead. It still drives me nuts that I have the left side. I will find out what happens soon if I happen to be BRCA + as my mom and aunt are being tested soon.

    Next problem, I started about a month or so ago JUST looking into my reconstruction options. I have an HMO insurance and can ONLY see in-network doctors or they pay NOTHING. Okay, my in-network doctors only do implants. I have had radiation. I and most everyone else knows 50% of implants after rads can/do fail. I submitted a referral to the next biggest city closest to me for a doctor that does DIEP, SGAP, etc. They denied it saying I had in-network options. In other words, they are forcing me to have an implant if I want reconstruction at all. The doctor himself gave me a call about 2 weeks ago and said he was literally p*ssed and this was against the women's act and against the law. I have not heard back from him yet, so need to give him a call back. I think I have 6 month's to file a grievance and even though other things have come up right now that might delay my reconstruction, I think I need to file the grievance and go all the way that I can with this, as it angers me to no end that they can first deny me a bilteral, and now are telling me what kind of reconstruction I can have.

    Also, Debi, thanks much for your info on the 30 days to get insurance in your state without them being able to use your pre-existing condition(s) against you. 

  • mradf
    mradf Member Posts: 398
    edited February 2010

    The Healtcare Summit is starting right now and being carried live on TV.

    If you're at work, like me, it's streaming live on several sites.  I listening at whitehouse.gov:

    http://www.whitehouse.gov/live

    Be well,

    Maria

  • JudyAnnW
    JudyAnnW Member Posts: 28
    edited March 2010

    Hello everyone -

    I live in California.  Last summer, Pacific Care advised me my new rate would be 2100/month

    to cover my husband and myself.  We are both over 50 and my husband is diabetic.  Of course,

    that was unaffordable so I terminated coverage.  I had already exhasted COBRA from my

    last job.  The "insurance" we were able to afford is a kind of discount card that lowers the

    cost of doctor visits and prescriptions but does not cover surgery of anykind, or any type

    of testing.  I was diagnosed with cancer in January.  Luckily, it is very early and a very

    small tumor.  My surgery, of course, is being delayed until some kind of coverage is

    found.  Has anyone heard of "Every woman Counts" or "Saving our Sisters" in the state

    of California ?  It appears this will be my only hope.  Now that I have cancer, I am sure

    no one will cover me with a preexisting condition.  Thanks for letting me vent my

    frustration.  Isn't it ironic that for the first time in my life that I don't have "real"

    insurance, I need it the most.

    Love to all,

    Judy
      

  • Bren-2007
    Bren-2007 Member Posts: 6,241
    edited March 2010

    Judy .. the program you're talking about in CA is funded by the CDC.  Each state is required by law to administer a Breast and Cervical Cancer Screening Program.  Normally if you have already been diagnosed with cancer you won't be able to qualify for the program.  However, if you contact your local health department, they can give you information about special funding through that program that may be able to help you qualify.  If cancer is detected on screening through that program, state medicaid kicks in to cover the cost of treatment and follow-up. 

    Please contact the health department and ask them about this program and see if they can help you.

    Good luck and best wishes.

    Bren

  • gale1525
    gale1525 Member Posts: 232
    edited May 2010

        JudyAnnW for California go to cobrahealth.com/statehighriskpools.html. You should be able to get health insurance.

  • MaryNY
    MaryNY Member Posts: 1,584
    edited May 2010

    I wish there was a proper place for the this thread on one of the forums. Thanks Madalyn for directing me here.

    I was laid off at the end of Jan last year (Jan 2009). I qualified for COBRA but my 18 months will be up at the end of July. For 15 months (Mar 2009--May2010), I was able to avail of the ARRA subsidy, so my monthly payments were $173. But for June and July, I will have to pay the full premium again which is $493.  That's bad enough but then I'm not sure what I'll do for insurance. Will my current provider be obliged to offer me continuation of coverage? If they do, can they charge me whatever they feel like. If they don't offer me coverage, is it going to be very difficult for me to get coverage with my preexisting condition?

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