Taxotere is a nightmare

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  • tracie23
    tracie23 Member Posts: 598
    edited March 2011

    Hi Lago My insurance went into effect in June and I was diagnosed in June. But I didn't know I had the lump until they did the biopsy and the diagnoses wasn't until later in June. I don't know what I am going to do. I really wish I could run a way. They did a 5yr medical review When I got applied for the insurance in April was approved in May and had to wait until June and that is when I went to the Dr. and all this shit started. I answered all the questions honestly So now they are going back to everyone I paid and they are know going to seek there money back. I can't even think straight. My doctors even said you can't call it pre-existing ... even though the insurance is new I wasn't diagnosed until after the fact...

    From my insurance book: Preexisting Condition: Means the existence of symptoms which would cause an ordinarily prudent person to seek diagnosis, care or treatment within the twelve-month period immediately preceding the effective date of the paricipants coverage, herunder or a condition for which medical advice or treatment was recommened by a physican or a professional blah blah blah blah.....

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  • marjie
    marjie Member Posts: 1,134
    edited March 2011

    Tracie - That's awful.  What is the point of paying for insurance if all they do is look for ways to get out of honouring their side of the contract.  The Canadian medical system is far from perfect, but I am sure glad I have not had this additional worry on my plate! We have provincial coverage for all the medical stuff like doctors, surgery, scans, hospitalization, chemo and rads - but prescription drugs are extra and we were lucky to have benefits that covered them.

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  • lago
    lago Member Posts: 17,186
    edited March 2011

    Did you have insurance prior to this? Was there a lapse. I think if there was a lapse they may try to call this pre-existing but because you didn't know it existed I don't think they can do that.

    Does your insurance have a 1 year wait period or something?

    Seriously this is going to be a PITA and you will have to fight and threaten but  it sounds to me that you will be covered. Did you talk to someone at BC&BS and ask why they claim it's a precondition. Is there any record of you reporting these symptoms to any doctor prior to June? Sorry to ask so many questions but this is BS! 

    Check out this link from the American Cancer Society. It has very good advice:
    Handling a claim denial -- what to do when insurance won`t pay for a prescribed service     

    other links that might help:
     Health Insurance and Financial Assistance for the Cancer Patient  

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  • Omaz
    Omaz Member Posts: 5,497
    edited March 2011
    tracie - We are all here for you.
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  • tracie23
    tracie23 Member Posts: 598
    edited March 2011

    I was just looking at the ins. and yes it is a one year wait for preexisting.  BCBS said the BS put in his notes that the patient felt a lump 1 week before..... WHY !!! and the is what bcbs is basing preexisting off of????

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  • tracie23
    tracie23 Member Posts: 598
    edited March 2011

    lago thanks for the links.. I am looking at them now...

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  • Mimidi
    Mimidi Member Posts: 231
    edited March 2011

    I finished my A/C nearly two weeks ago and I start Taxotere this Thursday for twelve weeks.  I was hoping Taxotere would not be quite as bad.  I guess I was wrong.

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  • Omaz
    Omaz Member Posts: 5,497
    edited March 2011
    Mimidi - Everyone is different and reacts different to tax.  You may not have a bad time.  Please consider icing your fingers and toes during treatment to prevent possible nail problems.
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  • shooshoo23
    shooshoo23 Member Posts: 96
    edited March 2011

    Tracie,

    I am so sorry! Insurance is a neccessary evil! I'll be praying that everything works out for you. 

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  • lago
    lago Member Posts: 17,186
    edited March 2011

    Tracie I for once am speechless. F*ck your insurance people YellYellYell

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  • marjie
    marjie Member Posts: 1,134
    edited March 2011

    Iago - I agree, Tracie that just sucks. Fight it all the way.

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  • pejkug3
    pejkug3 Member Posts: 902
    edited March 2011

    Oh, Tracie!

    What a crock!

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  • bdavis
    bdavis Member Posts: 6,201
    edited March 2011

    Tracie... That just seems criminal... I would FIGHT FIGHT FIGHT for coverage!!!

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  • Survivorwoman
    Survivorwoman Member Posts: 620
    edited March 2011

    Tracie - I think you might want to call the Patient Advocate Foundation at 800- 532-5274. Let them help you fight them.

    http://www.patientadvocate.org/

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  • SAMayoFL
    SAMayoFL Member Posts: 958
    edited March 2011

    Mimidi, the first six weeks of Taxotere were a breeze for me.  I felt more like myself, had more energy and the crazy emotional roller coaster I was on during A/C seemed to level out.  I have now completed 9 of 12 and the last three have been more difficult but still doable.  I have some fatigue like I did with A/C and I am swelling.  Good luck.  I hope it is an easy ride for you!

    Tracie, that completely stinks.  I work for an attorney.  Tomorrow morning I will ask where the best place for you to start is.

    Susan

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  • shooshoo23
    shooshoo23 Member Posts: 96
    edited March 2011

    I love all the support and information you ladies provide! Tracie, I'm with everyone else, fight this! It's completely unfair!

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  • Linda-n3
    Linda-n3 Member Posts: 2,439
    edited March 2011
    Tracie, I am also in there with everyone else for you on this one!  The last thing you need is to have to fight with the paper-pushers when you are already not feeling well.  I had great difficulty even understanding my bills when compared with the "Explanation of Benefits (EOB)" - those expanations are puprposely convoluted so you cannot possibly understand them!  I had my sister help out because she deals with getting providers paid every day and I was going crazy with them.  Just become as royal a PITA as they are to you!  The squeaky wheel will get the grease, and if you need an attorney, it may be worth it, although that also will cost you additional time and money.  But an attorney can figure out what is going on and give you much more specific advice.
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  • tracie23
    tracie23 Member Posts: 598
    edited March 2011

    someone mentioned The Obama law from this fall I can't find it I can't even think straight Can someone help me find the link

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  • nora_az
    nora_az Member Posts: 720
    edited March 2011

    Tracie,

    I have been reading your posts. I dont have anything to add to be able to direct you anywhere but I wanted to let you know I've been thinking about you and hope everything turns out ok. My heart really went out to you when I started reading all the crap you are going through.

    Hugs XXXXXXXX

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  • tracie23
    tracie23 Member Posts: 598
    edited March 2011

    nora_az I don't think I can handle anymore.....thank you for thinking about me just pray that this will all eventually work out.

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  • lago
    lago Member Posts: 17,186
    edited March 2011

    Tracie is there any way your surgeon can remove that note of you reporting thislump  a week earlier? This seems like the route of the problem.

    I would also contact the high risk pool in your state. I know it says you have to be 6 months without coverage but that's not always true. It said that in IL and we didn't have to go without insurance. We had continuous coverage. http://www.txhealthpool.org/  

    BTW if you didn't have continuous insurance coverage (no more than 1 month lapse between insurances) then the insurance company can deny all pre-existing conditions. In 2014 this will not longer be the case. Currently children can not be denied coverage of pre-existing conditions.

    Here are a few links on the health law. Not sure if any pertain to you now:
    link one 
    linke two    

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  • Mimidi
    Mimidi Member Posts: 231
    edited March 2011

    Sam I have to tell you that you made me feel better.  I think I came throuhg A/C pretty good.  No SE that I couldn't live with.  If the taxotere is no worse than the A/C I know I can make it. 

     What has bothered me the most is the fatigue and the chemo fog or brain.  I have all this want to and no energy to do anything.  Thank goodness I am older and my children are not at home.  All I have to worry about is taking care of myself and my hubby who does peritioneal dialysis at home each night.  My hat is off to all the ladies with young children to care for.  I can't imagine how they mangage.

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  • Omaz
    Omaz Member Posts: 5,497
    edited March 2011
    Tracie - I hope you get a break from somewhere!  Hang in there.  Do you have a friend who can help you with finding out information?
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  • tracie23
    tracie23 Member Posts: 598
    edited March 2011

    lago he can't take it out it is already at the Insurance company and yes they just told me that is what they based there decision on.....is what he had in his file. I asked for it in writing and they said I would have to supoena there records in order to get any information on there notes about me. I will still fight it. They will send me a release form for my medical records but it will not have any notes. But she did offer up that peice of info about the one dr. notes.

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  • Omaz
    Omaz Member Posts: 5,497
    edited March 2011

    Tracie - would the week previous have put you in May instead ofJune?

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  • TonLee
    TonLee Member Posts: 2,626
    edited March 2011

    Tracie,

    First of all.  Any "record" or "notes" a Dr keeps on you, you are by law, permitted to see.  Your Dr would only have sent a copy to the insurance co.  Call his office and have them fax you a copy as well.

    Second, if you had at least a full year of health coverage at your previous job and you enrolled in your new health plan without a break of 63 days or more, your new health plan cannot subject you to the pre-existing condition exclusion.

    This is part of HIPPA known as "Credible Coverage."

    Did you lose coverage for more than 63 days?

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  • TonLee
    TonLee Member Posts: 2,626
    edited March 2011

    From my insurance book: Preexisting Condition: Means the existence of symptoms which would cause an ordinarily prudent person to seek diagnosis, care or treatment within the twelve-month period immediately preceding the effective date of the paricipants coverage, herunder or a condition for which medical advice or treatment was recommened by a physican or a professional blah blah blah blah.....

    Ok, so you know what they consider pre-existing.  Now.  Did you have insurance coverage in May with another company?  Were you uncovered for more than 63 days?

    If yes, you will have to get an attorney.

    If no, you had insurance (with someone else) before transferring to this new comp. then you're golden..it's just a matter of fighting it internally with the review process.

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  • lago
    lago Member Posts: 17,186
    edited March 2011
    Tracie if you did have coverage 30-59 days before then maybe the issue is they insurance company has no record of it. You will have to go call your previous insurance company and get a letter stating what dates you were covered. I've had to do that with every insurance coverage I've had.
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  • Omaz
    Omaz Member Posts: 5,497
    edited March 2011
    Good idea Lago!
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  • tracie23
    tracie23 Member Posts: 598
    edited March 2011

    I did not have insurance for 1 yr prior... My DH got laid off and we could not afford cobra.... My life sucks....It's not like I don't have enough to deal with

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