costs/budgets

imatthew · July 2010

costs/budgets

imatthew · July 2010

Since my wife's diagnosis earlier this week we're trying to figure out family finances for the next year (and if we can take that one last vacation before surgery).

Our high-deductible BC/BS PPO plan covers 80% of all approved costs after the first $5k. Since she's ER/PR negative, HER2+, and stage 1, we're assuming that she'll need either a lumpectomy/radition or a masectomy, followed by a year of herceptin and reconstructive surgery (obviously this is a best guess based on what we now know, and subject to a great deal of variance).

So far I've been unable to find much of anything as to what this would all cost. Is $100k a safe assumption (meaning we'd have to pay 20% or $20k out of pocket), or am I way off? Thanks in advance!

BarbaraA · July 2010

I had 2 surgeries and 16 rad treatments and grand total was around 70K. If she has to do chemo, 100K sounds about right.

Sue-61 · July 2010

I you have a 5 K deductible. check to see if your plan also has an out of pocket maximum.

I had a $1500 deductible on my ppo type of plan, but the maximum I would pay out of pocket was 3K so that worked out well.

Keep in mind that if your medical costs are 7% or 7.5% of your income, they are deductible on your tax return. I can look up my claims from 2009 so will get back to you with the costs. Most insurance companies have negotiated costs with the providers so it's hard to tell how much anything will actually cost the patient......Sue

Sue-61 · July 2010

OK, imatthew, I just looked up the big claims, but keep in mind I had bilateral mastectomies and was HER2 neg. So no herceptin costs, but you could call your pharmacy at your insurance company and ask the price. I can look mine up on line thru my ins co.

Mastectomies were 47K, but insurance only paid 12K

Surgeon was 8K but again insurance paid at the negotiated rate: $3200 bucks

Anesthesia was $2300 but ins paid $1160

Pathologist was $1951, ins pd $900

Onc visit was $500 but was only paid $107........Hope this helps.

Most hospitals have a social worker or financial person who will sit down with you and find resources to help with payments. I have an idea this is not going to be as expensive as you thought! Please call your insurance company and request a nurse case manager. (I am a retired one). The CM can be very helpful in knowing resources in your area that help if you really get stuck for money. Please let us know what you find out. Sue

imatthew · July 2010

thank you to all for your responses. We have a $1 million lifetime max, so we're good for now. Our biggest concern is that I had promised my wife a vacation at the end of the month and we're wondering if we can afford it before she starts her treatments. I think the vacation would help her emotionally before going through the ordeal of surgery and follow-on treatments. thanks again!

BarbaraA · July 2010

By all means-take her on a vacation!

Sue-61 · July 2010

imatthew, I am not talking about life time max.......that is different from OUT OF POCKET costs. Many plans w hi ded have a maximum that you will have to pay. I worked for a nation wide insurance company and everyone I case managed had a different pollicy. I am hoping you have like 10 K max or something like that......Sue

Sue-61 · July 2010

I also sent you a private message......

imatthew · July 2010

Thanks again - It's a high deductable PPO through BC/BS, with a healthcare savings account. I looked up the out-of-pocket maximum and it's $10k.

I'm really confused though, the plan says it pays up to 80% of eligible expenses if we use an in-network provider. Am I correct in assuming that's 80% up to $10k, then 100% above $10k?

Thanks!

Sue-61 · July 2010

imatthew

Let me see if I can explain it but I think you need to call the 800 # on the back of your card and talk to member services. And then request a case manager RN as she/he would be most helpful in answering all your questions.

How my plan worked..........I paid the first $1500. I THINK you will pay the first $5K.

Then I paid a percentage of all the other costs until I had paid 3K, which is my max, and then services were covered at 100%! I paid no more once I hit the max. I hope this is what you mean about 100% above the 10K.

All so confusing, especially having to deal with the new diagnosis. Best wishes to you and your wife, Sue

maxie918 · August 2010

I had 6 tch at 24K each after ins plus 11 just hercepton @12k each 156k for 2009, 120k 2010 that does not include the echos every 3 months. my ins has yearly max 3000 out of pocket. I could not have afforded 20%. hope this helps.

Ca1Ripken · August 2010

I'm same as Sue... as soon as I reached my policy "out of pocket maximum," I have literally paid ZERO for everything! I go to the pharmacy to pick up multiple prescriptions, and pay nothing... get no more bills in the mail, etc. I have paid 0 since I reached that maximum! Of course, check and see if you are lucky enough to get all your treatment within your policies "year." I, unfortunately, am about to reset to a new year in October and will still be in treatment, so have to start all over again with a new year "maximum." GL. And, by all means... take the vacation!! Hope this helps!! GL to you and your wife; I will say a prayer for your family. (((HUGS))

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