Taxotere is a nightmare
Comments
-
I'd still appeal it, and re-appeal, and appeal again, within your insurance company.
Can you ask your Oncologist/Cancer Center if they have financial counseling or a social worker you can talk too? That might be a good place to start since there are often programs available you don't know about.
-
Shoot!
-
How old are you Tracie? You may want to call these people....
-
and look into the high risk pool insurance. They can' refuse a pre-condition. Ironically if BC&BS knew you had breast cancer they wouldn't have insured you in the first place. Since you hadn't been diagnosed at that point how were either of you to know. IF you had known you would have gone with the high-risk pool insurance in your state to begin with.
I think you have a case. They can't play it both ways.
-
Check with the American Cancer Society - they have a financial assistance section too.
TonLee - my husband is recently retired from the AF as well. Are you using Tricare? They have denied my Mammoprint as "experimental" testing. Agendia appealed it and from what I can tell it is the only source of my ER/PR/Her2 status. How else would they have determined my treatment approach without this info. It is a $5,000 bill in question. Has anyone else had this happen?
Tracie - I would def take the squeaky wheel approach - a lot of times the more you press the ins. co, especially if their next contact comes from your attorney, the more cooperative they become.
-
They do though Lago.
Pre-existing does not = knowing. Technically she could have found the lump 10 months after starting with them and they could do this if there is a 12 month clause.
And there is usually a 12 month clause...they figure anything serious (ie expensive) won't be ignored for an entire year.
-
SpecialK,
Tricare Prime, yes. I didn't have a Mammoprint. What is it?
They sent the material from my MX and my SLN to a lab to be dissected, stained etc..but that's it. Is that what you mean?
~Editited!~
Ok I read what it is...yeah Tricare isn't likely to pay for a prognostic test...my Onc told me straight up they wouldn't pay for an Oncotype Test because I'm Her2...
The thing is though, did you sign paperwork allowing your insurance to be billed for this test? Because you are supposed to be told UPFRONT how much Tricare pays and your co-pay, long before any labwork is sent out.
-
Tricare has been fantastic working with me. As a matter of fact, they went to bat for me when the wig shop (Tricare provider) tried to get me to pay the "balance" (after my co-pay and Tricare's allowable) on my wig. Which you know is a big no-no for a network provider.....they agree to take what the insurance allows and write off the rest.
-
tonlee I am 40
-
Tracie,
Then you may qualify for the link I provided....I'd shoot that woman an email right now.....if she can't help you directly with her organization, she may be able to tell you who can.
~Edited~
It says in the article it can't be retroactive...but I bet if you put all this down in writing the woman in the article will be able to give you some organizations/non-profits that will help you. Can't hurt to ask.
-
Tricare (I also have Prime) has been fantastic - this is my only issue. When I had my US guided hollow-core needle biopsy they withdrew 5 samples. 4 went to regular path and 1 was sent to a lab in California that does genetics as well as ER/ER/Her2 testing. This decision was made by the breast center radiologist. They do it with everyone. When I went to my very first appointment with my BS he already had my results so could say with certainty, surgery then chemo. To my knowledge my receptor status was not done subsequently on my breast tissue after BMX. I need to ask that question on Thursday when I go for TCH#2.
-
Are you being treated at a military facitility?
If so, if they sent it off...then it is on them, not you. If you didn't sign anything agreeing to PAY for the genetic testing then you don't have to pay.
TriP sent me to Dayton Children's Hospital for genetic testing BRCA 1,2 and PTEN. They took blood two times, and it was totally covered. However, a friend of mine (exact same diagnosis and treatment, but a week behind me) went to Children's, spit in a cup, and was told it would cost her $1,300 co-pay, OR up to her yearly deductible for the BRCA. She's not doing it.
But the point is they had to tell her UP FRONT before they sent the sample, what she was responsible for financially...otherwise it's on them. The lab in Californnia will attempt to collect from Children's because that's who sent it.
Have you went to talk to your Tricare Rep? If so, what did s/he say?
-
"Technically she could have found the lump 10 months after starting with them and they could do this if there is a 12 month clause."
I know they can do that but is that legal? Technically all breast cancer once found is pre-existing. Mine was fast growing so they say I had if for only 4 years prior but other women with slower growing tumors have had theirs for 10 years.
-
Yes it is legal.
Each insurance co, and state have their own definition of pre-existing....it's not about WHEN it started, but when it was found...if found in the 12 month window then it is considered pre-existing...
They can't tell me how long it took mine to grow. I think it started when I stopped nursing 6 1/2 years ago...but it doubled in size in just a couple months once I had the US. All that is superfluous to the point however....
I still think Tracie will be able to find a non-profit to help her out....and I wouldn't rule out appealing to the insurance co. The fact they already PAID these bills and are now trying to get that $ back speaks a long way in her favor....not all providers may feel inclined to give money in their pockets back with the hopes of collecting from an individual. They may balk.
And think about it...if she takes them to court..her entire treatment was based on the fact the insurance co was paying her bills...(if they told her in the beginning they wouldn't cover it, she would have been able to get the pool insurance you're talking about...but she acted in good faith, paid her premiums and went with the care they covered.....now, almost a year later, they want to stop and have her pay FULL price for everything when they originally (and in writing) okayed it? I don't see a judge siding with the insurance co.
-
None of my treatment is in a military facility aside from my initial mammogram/ultrasound. The military radiologist referred me off base because they have no hospital proper at MacDill, only a clinic. They referred me to the BS first through Tricare and also to the breast center rad. They had a referral for procedures prior to the US guided biopsy. I am sure I signed the usual paperwork prior saying I would be responsible for paying whatever was not covered but that was for the rad facility. The facility (radiologist) casually informed me they were sending the sample to the Mammoprint place in Cali. It is their standard but you would think they would have known it isn't covered by my insurance. I did not have a separate referral for it because I didn't know I needed it. All of this was within a week of dx so I was already reeling. I had subsequent testing for BRCA (I am adopted) done separately and have not had any issues with that - they say they will inform you prior to testing if your insurance won't cover it. You would think the Mammoprint folks would have that obligation as well.
-
Is the insurance through your work or your DH? Is it a self funded plan (I think that is the right word)? There may be angle here with the employer...maybe.
-
Just got back from TCH #2, thought I better write before I descend into SE hell...
Tracie I'm just getting up to speed on the insurance mess and I am so sorry that you have to deal with this in the middle of trying to deal with your treatment. I certainly hope that fighting the insurance company works and an attorney might not be a bad idea. As TonLee suggested, it is in your favor that the insurance company has already been paying all along. A review would certainly indicate that they felt they should be covering the claims or they wouldn't have been paying them. And you were being honest all along and acting in good faith. It's just going to take someone to put some pressure on them. If you can't afford an attorney, do you have access to some sort of Legal Aide (that's what we call it in NY) for representation?
SpecialK Sounds like you have your own version of coverage problems-sorry about that! I hate this crap! When I was diagnosed I was under my DH's insurance which has a terrible network but I managed to sign up for coverage through my employer at the last minute during open enrollment which is the only thing that gave me access to decent providers in my area. What a mess we have with the insurance companies!!! How's your hair? Is that helmet still in place:)? I don't know how you're doing it...my hair drove me nuts and had to go...Well, the chemo is catching up and I need a nap now. Here's a toast to the triplets and a wish for a better round 2!!!
-
Dragonfly,
I hope you have less SE's this time around. I do notice with mine that every single one is a bit different. Go figure!
-
dragonfly - def take a nap! I found that theBenadryl hit me a little day of tx. Not sure what my hair is doing. I am reluctant to shave it until I have to. Right now it still looks like regular hair unless I touch it and then I can just pull it out. I gently brushed it yesterday before I ran errands, got a brush full of hair, then lightly sprayed it so I wouldn't leave a trail like Hansel and Gretel. There is not a lot of hair on my pillow and I just keep picking it off my clothes. I am strangely determined to go to the next tx with hair DAMMIT! I don't know why I have this goal - it makes no sense! I hope you have no headache, or only slight, this time. Please keep me posted if you can - I will be very curious since we had such similar experiences last time. I know what you mean about the hubs - sometimes they don't get it! A previous track record of dealing well can be a detriment! Not sure what mine would do if I fell apart...
A triplet toast to you too!
-
Special K
I remember going to my 2nd TCH with hair. I was in a room with a bed and when I got up to use the bathroom I looked on the white pillowcase and it was LOADED with hair. I was in the bathroom and sort of tried to finger combed my hair and I kept pulling more out. I was leaving trails of hair all over the place. It was the very next day I had it all buzzed off.
-
annie, My insurance is my own... his was so expensive that it didn't make sense
Thank you everyone for all your suggestions, I have called the ACS . I am also putting a letter together to send to blue cross. I am trying to find the CFO of BCBS and any other higher ups to send it to. I will be fighting back ... I never asked for cancer , I never knew I had it, I can't believe they would do this to me I am one small nothing to them is getting the money back going to make them any richer??????? FUCK THEM
-
Special,
I've spent a lot of time with Tricare over the last two weeks. If you didn't specifically give permission for them to send it, in writing which would also say you're liable for charges, you are not responsible. It can't be a generic form saying you will pay for anything not covered...it has to be a specific Tricare Waiver for non-covered services.
I think if you meet with a TriCare Rep they will tell you this and this is just a matter of getting it sorted out.
First thing I'd do is go through paperwork and see if I signed any waiver saying I would assume financial responsibility for this test. If NOT, and such a document doesn't exist, then you are NOT responsible.
It is up to the Radiologist (or whoever sent it) to secure agreement and promise of payment before sending it. If they didn't..they have to suck it up and pay.
Sounds like they essentially ordered something not covered by your insurance without your written permission. That means they have to absorb the cost (if they are a Tricare provider)...if they're NOT a Tricare provider, by law they can still only bill you for 115% max of the Tricare allowable...in this case 115% of nothing is nothing...
I wouldn't let this stress you. Go talk to a Tricare Rep. I think they'll be able to help you. And let me know!
-
nora_az - I have a feeling this will be the same. I will be in a recliner that is hair colored and vinyl so hair won't stick! It is hanging on by a thread but nobody can tell it is falling out just by looking at me - only I can, so I figure I will hold out on the shaving.
Tracie - I have had to get pre-approval prior to every procedure (except the Mammoprint deal I outlined earlier) but I agree that your insurance company's payment is their acceptance of obligation. Trying to get those payments back after making them in good faith seems really underhanded regardless of pre-existing interpretation. They knew when you began paying premiums and they knew your date of diagnosis prior to paying your providers. Does your state have an insurance commisioner? I would be curious about their take on it.
-
tracie23 before you send that letter out see if you can talk to a lawyer or a social worker at the ACS. You don't want to find out later that you wrote something in that letter that could work in their favor.
and keep bugging the ACS if you don't get a call back. They really are a non profit. I was pretty obvious that they watched the budget when I visited the office in Chicago. Great location but the office was sparse.
-
Tracie
I know its different cause Im in Canada, and it was a mortgage insurance i had, for critical health ins which cover cancer, I had just purchased just a little over a yr ago, any how when i was diagnosed with cancer i sent the claim forms, it took them from Oct till late feb to approve it, and after fights and fights and calls...it was so fustrating and stressful. I had a phone interview when they approved me and I was more than sure i told them i had fibroids previously Ive been getting them since i was 20 and all biopsies were always clear so why would i lie. They asked my doctor for file since 2007 she even got mad because she to go through all the file three times, cause they kept saying that they didnt receive it (BS)... the first time they said they would review just what they had because they never got the file from doctor, they said i was denied, first time because I didnt tell them I had a tumour, which I didnt, then it was not that it was because i was never covered yet i had been paying all this time, then it was because I didnt say yes to some stupid question, keep in mind they denied me without even looking at my file...so we went to see a lawyer, he told us that if they didnt have the a copy of the interview over the phone they better prepare themselves, so my husband call them and told them we would be going to court, and that the lawyer need all the info they had on us...when they sent it I, it showed i had said yes to the question, i also called and asked for a copy of the phone call, ofcourse they said that they dont keep them (what ever) anyhow to make this shorter about a month after they it turns out that i was approved.....even if you dont have a lawyer ( or go to legal aid, im sure you guys have that over there too), a lot of ppl dont fight back, but you need to, we dont ask to get sick...like seriously that got me so mad about my insurance it got the point that they said i had cancer before i got insurance like seriously Ill wait for my cancer to get worst so im gonna wait a whole yr and not treat my cancer so i can go through chemo loose my hair, my breast, go through crap, and risk my life...grrrrr just remembering gets me mad!! governments really need to step up and have more control about ins cause a lot of ppl get rob! Car insurance in Canada went up this yr because auto ins are loosing money? like really?? you need to fight even more i mean your ins is even more important then mine cause they are threating your life you need treatment! you should so sue them!! for stress is not good for us right now! GO get them girl!!
-
Tracie
My heart goes out to you. You don't need this crap on top of everything else. But - you need to fight for your rights. It's true the squeeky wheel gets the oil. You need to become in need of oiling girl!!
I know it's hard with everything else you are dealing with - but we are all behind you sending you strength.
Trish
xoxo
-
hi girls, I just spoke with the Texas Insurance commission and the woman who helped me said I can fill out a complaint form on line and they will take care of getting all the info ( no supoena needed) from BCBS she said I have every right to my information . Your right coni I didn't ask for this I went for a mammogram and there it was.... I am so exhausted from todays events I could pass out... Thank you everyone for your advice and comments it means a lot me.
-
Big hugs to you Tracie! XXX
-
Tracie...big (((hugs))). I am stunned.
-
tracie you go girl! Stupid of BC&BC to pick a fight with a cancer survivor. We survived chemo we can fight an insurance agency.
♥ ♥ ♥ hugs ♥ ♥ ♥
Categories
- All Categories
- 679 Advocacy and Fund-Raising
- 289 Advocacy
- 68 I've Donated to Breastcancer.org in honor of....
- Test
- 322 Walks, Runs and Fundraising Events for Breastcancer.org
- 5.6K Community Connections
- 282 Middle Age 40-60(ish) Years Old With Breast Cancer
- 53 Australians and New Zealanders Affected by Breast Cancer
- 208 Black Women or Men With Breast Cancer
- 684 Canadians Affected by Breast Cancer
- 1.5K Caring for Someone with Breast cancer
- 455 Caring for Someone with Stage IV or Mets
- 260 High Risk of Recurrence or Second Breast Cancer
- 22 International, Non-English Speakers With Breast Cancer
- 16 Latinas/Hispanics With Breast Cancer
- 189 LGBTQA+ With Breast Cancer
- 152 May Their Memory Live On
- 85 Member Matchup & Virtual Support Meetups
- 375 Members by Location
- 291 Older Than 60 Years Old With Breast Cancer
- 177 Singles With Breast Cancer
- 869 Young With Breast Cancer
- 50.4K Connecting With Others Who Have a Similar Diagnosis
- 204 Breast Cancer with Another Diagnosis or Comorbidity
- 4K DCIS (Ductal Carcinoma In Situ)
- 79 DCIS plus HER2-positive Microinvasion
- 529 Genetic Testing
- 2.2K HER2+ (Positive) Breast Cancer
- 1.5K IBC (Inflammatory Breast Cancer)
- 3.4K IDC (Invasive Ductal Carcinoma)
- 1.5K ILC (Invasive Lobular Carcinoma)
- 999 Just Diagnosed With a Recurrence or Metastasis
- 652 LCIS (Lobular Carcinoma In Situ)
- 193 Less Common Types of Breast Cancer
- 252 Male Breast Cancer
- 86 Mixed Type Breast Cancer
- 3.1K Not Diagnosed With a Recurrence or Metastases but Concerned
- 189 Palliative Therapy/Hospice Care
- 488 Second or Third Breast Cancer
- 1.2K Stage I Breast Cancer
- 313 Stage II Breast Cancer
- 3.8K Stage III Breast Cancer
- 2.5K Triple-Negative Breast Cancer
- 13.1K Day-to-Day Matters
- 132 All things COVID-19 or coronavirus
- 87 BCO Free-Cycle: Give or Trade Items Related to Breast Cancer
- 5.9K Clinical Trials, Research News, Podcasts, and Study Results
- 86 Coping with Holidays, Special Days and Anniversaries
- 828 Employment, Insurance, and Other Financial Issues
- 101 Family and Family Planning Matters
- Family Issues for Those Who Have Breast Cancer
- 26 Furry friends
- 1.8K Humor and Games
- 1.6K Mental Health: Because Cancer Doesn't Just Affect Your Breasts
- 706 Recipe Swap for Healthy Living
- 704 Recommend Your Resources
- 171 Sex & Relationship Matters
- 9 The Political Corner
- 874 Working on Your Fitness
- 4.5K Moving On & Finding Inspiration After Breast Cancer
- 394 Bonded by Breast Cancer
- 3.1K Life After Breast Cancer
- 806 Prayers and Spiritual Support
- 285 Who or What Inspires You?
- 28.7K Not Diagnosed But Concerned
- 1K Benign Breast Conditions
- 2.3K High Risk for Breast Cancer
- 18K Not Diagnosed But Worried
- 7.4K Waiting for Test Results
- 603 Site News and Announcements
- 560 Comments, Suggestions, Feature Requests
- 39 Mod Announcements, Breastcancer.org News, Blog Entries, Podcasts
- 4 Survey, Interview and Participant Requests: Need your Help!
- 61.9K Tests, Treatments & Side Effects
- 586 Alternative Medicine
- 255 Bone Health and Bone Loss
- 11.4K Breast Reconstruction
- 7.9K Chemotherapy - Before, During, and After
- 2.7K Complementary and Holistic Medicine and Treatment
- 775 Diagnosed and Waiting for Test Results
- 7.8K Hormonal Therapy - Before, During, and After
- 50 Immunotherapy - Before, During, and After
- 7.4K Just Diagnosed
- 1.4K Living Without Reconstruction After a Mastectomy
- 5.2K Lymphedema
- 3.6K Managing Side Effects of Breast Cancer and Its Treatment
- 591 Pain
- 3.9K Radiation Therapy - Before, During, and After
- 8.4K Surgery - Before, During, and After
- 109 Welcome to Breastcancer.org
- 98 Acknowledging and honoring our Community
- 11 Info & Resources for New Patients & Members From the Team