My job changed my insurance mid treatment

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martiparty
martiparty Member Posts: 15
edited June 2014 in Employment, Insurance, and Other Financial Issues

I had bilateral mastectomies on Dec 20th.  At the time of my surgery they started my reconstruction by putting in expanders.  On Jan 1st, my employer changed my insurance carrier.  My plastic surgeon is not a provider with the new insurance.  Now I need $2500 to switch out the expanders for implants.  I am broke, really.  I am in collections already with my hospital bills.  It is overwhelming.  I hope I can even go back to the hospital since I am in collections.  The collection agency called me & I told them the truth.  I can only pay about $20 a month on each of the bills (there are 3 of them).  Plus, I am paying of anesthesia bills and other lab bills, etc.  I can only make small payments.  The collection agency said it will still go on my credit report even though I am making payments.  I just said "Fine, that's all I can do" and slammed the phone down.  It is very depressing and discouraging to have no money at my age (46).  Guess I am just complaining.  There's not much I can do.  How long can I keep expanders in?  They are very uncomfortable & I hear that implants feel better.

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  • AnneW
    AnneW Member Posts: 4,050
    edited March 2011

    Is there no one in-network for you who can finish the job? I would not think that this is an unusual occurence.

    I'm so sorry you're having issues with finances and paying medical bills. This is when I usually start shouting out for Universal Health Care, but I'll leave it off. That doesn't help you right now.

    Hang in there, and just do what you can when you can.

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  • jenn3
    jenn3 Member Posts: 3,316
    edited March 2011

    Check with your in-network providers or call the insurance company to see if you can do something based on "special circumstances" because you were already in treatment when this happened.  Also, go to your HR Dept and talk to your benefits coordinator to see if they can offer some assistance.

    As for the bills, medical bills on your credit report really don't ding it that much.  As long as you're making an effort to pay the bill @ $10 or $20/month and you make the payments you'll be fine.  Don't let them convince you to pay it with a credit card or take out a loan, make your monthly payments and leave it at that - there is nothing you can do. 

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

    I would also talk with the original plastic surgeon.You might be able to negotiate something.

    Even if his/her costs aren't covered will the facility s/he uses be in network. The surgeon's cost is minimal compared to everything else. My PS is out of network but the facility isn't. My old insurance (cobra) covered 70% for out of network.The high risk pool insurances I'm on covers 60% for out of network. I start a new insurance in April. It will be interesting to see what they cover for out of network.

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  • mrsnjband
    mrsnjband Member Posts: 1,409
    edited March 2011

    Don't let the "collecdtions" people freak you out.  A lot of the times they say those things just to scare you. In most states, as long as you are paying on a bill they can't do anything to you.  After dealing with these "collections" people, I no longer pay money to them, I pay the money to 'whomever' I owe the money to!  That makes them really mad but there is nothing they can do about it!!! 

    My HD has 10 accounts from all of his CT scans from his cancer.  We pay them $10.00 a month, that all. They have finally given up on calling.  I made an excell sheet on each account with the check number & date of the month and send a print out of each account.  They actually have someone who checks them over & sends me corrections when I make mistakes. 

    So don't let them stress you out.  Do what ever you need to do to get well. 

    Sending love & support. NJ

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  • jdootoo
    jdootoo Member Posts: 253
    edited March 2011
    While I was going through  chemo, my insurance company was in negotiations with the hospital I was going to and all of my physicians. When I called to talk with someone at the insurance company, I was told I would have to switch hospitals. That wasn't working for me so I made a bunch of calls to the hospital, insurance company, etc. 
     
    Basically, there have been many laws passed that protect breast cancer survivors. Call the Attorney General in your area or an insurance advocate and find out what your rights are. I am almost positive that they cannot switch doctors on you at this point.
     
    My insurance company ended up settling their dispute, but i was told that I would have been able to remain with my original treatment plan.
     
    Hope this helps... you do not need these headaches at this time.

    One love, Jackie 
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  • martiparty
    martiparty Member Posts: 15
    edited March 2011

    Thank you for all your replies.  I see my plastic surgeon Tuesday.  I will ask them what can be done.  I am happy with his work & don't want to have to change doctors at this point.  I'll have to do some research.

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  • MondaysChild
    MondaysChild Member Posts: 591
    edited March 2011

    Who is your plastic surgeon that is no longer in network and what hospital were you at before? I am from Tampa also and may be able to come up with some ideas of who could follow your prior surgeon. Some have working relationships and can easily follow each other's work.

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  • AnnaM
    AnnaM Member Posts: 1,387
    edited March 2011

    I agree with Jackie, there are laws that protect women who are going through treatment for breast cancer, and those laws cover reconstruction. Please check with the AG in your state and if that doesn't bring some kind of answer, please see if your local hospital has a social worker on staff. Social workers can really help find answers, and if those answers aren't helpful, they can also find other ways to work things out.

    Good luck! 

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  • Shrek4
    Shrek4 Member Posts: 1,822
    edited March 2011

    martiparty, please do check these organizations, they might help you paying the bills. they will require some paperwork to be signed, but they will help.

    http://www.copays.org/ 

    http://ww5.komen.org/KomenNewsArticle.aspx?id=7742

    http://www.cancerfac.org/members.php 

    I know the first one I had called (forgot now which one) when I was afraid I wouldn't be able to pay premium AND co-pay while I was on BCBS was getting ready to send me money, but in the meanwhile I qualified for our State's program for BC patients so I did all my treatments through them.

    I wish you good luck with all my heart.

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  • martiparty
    martiparty Member Posts: 15
    edited March 2011

    Thank you so much.  I will check all of these options.  Tampa asked who my PS is.  My PS is Dr. Henry Redmon and I went to St. Joseph's Hospital last time.  I will write later as to what was done.

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  • martiparty
    martiparty Member Posts: 15
    edited March 2011

    I just tried the copay organization and was told to try again on the first of next month as they have met their allocated number of people to help for this month... something like that.  I will try again April 1st.

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  • MondaysChild
    MondaysChild Member Posts: 591
    edited March 2011

    martiparty,

    You might check with whomever covers for Dr. Redmon when he is not in town.  That person might be in your new insurance network and also would be familiar with his work and surgicial style and possibly able to following Dr. Redmon quite well.

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  • MaryNY
    MaryNY Member Posts: 1,584
    edited March 2011

    I would think your PS could make a strong case with your insurance company to cover your remaining surgery as an "exception."

    My insurance changed at the end of July and my breast surgeon was no longer in network. I had an appointment with her in August for my 12-month follow-up. I went to her office prior to that and explained that my insurance would not cover the visit and asked if she would just review my mammo results and do a phone consult instead. One of the ladies in her office said not to worry about it, that they "would take care of it" which I took to mean that they wouldn't charge me. When I turned up for the actual appt, a different woman was at the desk. I explained again about the insurance and she said they would try to bill the insurance company anyway. It turns out that the insurance company did cover it after all. I'm not sure if the breast surgeon's office did some extra paperwork to push it through.

    I think you have a much stronger case than I did as you are essentially left with only half the job done. You could argue that it would cause you emotional distress to change surgeons now as well as the fact that this surgeon already has a relationship with you and knows your case best.

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  • martiparty
    martiparty Member Posts: 15
    edited May 2011

    I've been trying that co-pay relief every month.  Today is the 1st of May and I tried applying again and it tells me that the "disease catagory I chose has been fully allocated for the month"  and to try again next month.  Maybe I have to apply at 12:01AM on the first of the month to get in.

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  • Fearless_One
    Fearless_One Member Posts: 3,300
    edited May 2011

    Can't you find an in-network PS?   I would rather do that than have to pay...   TE's are such a common surgery, I would think most PS's should be qualified to finish you up?   You can always look at their photos of their work if you prefer to see....

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