Tallahassee Democrat wants to know about insurance issues

I'm glad this issue is getting media coverage. While you're waiting for responses, you may want to scroll down and get a sample of problems patients have had, even when they have insurance: chemo not being covered; reconstructive surgery denied on the non-cancer breast, etc. Can you imagine what it's like to deal with the bureaucracy (and uncertainty) of health insurance companies during cancer treatment?

Overall my insurance was good during Tx, but now they are denying a B-MRI as a screening tool. (My tumor wasn't clearly seen by the mammo: completely missed on the side view; seen from the top view cuz it was just 1 cm from the skin. Yet my insurance company refuses to pay for a B-MRI, despite the fact that I have dense breasts, and that scar tissue from the lumpectomy can obscure a mammogram) I hope the Affordable Health Care Act doesn't get repealed or we'll see more patients denied coverage when they reach their annual and lifetime max (like that PoopStrong guy).

I am insured through Tricare, my husband is retired military.  I feel fortunate to have had the majority of my treatment covered, but have had several denials for things requested by my doctors.  One of my biopsy samples was sent for Mammaprint - which is done by Agendia - this is a genetic assay test and also provides definitive pathology for hormonal receptors and Her2 status.  The personnel in my breast surgeon's office did not obtain a referral for this test in advance.  Tricare does not cover this test because it considers it "experimental" even though it is FDA approved.  Payment was denied and initially I received a bill for approximately $5,000 for the test.  Fortunately I had not signed anything saying I would be responsible for anything insurance did not pay.  I requested an Assignment of Benefits form from Agendia, which is a form that says they will accept whatever insurance pays as payment in full.  Tricare paid a handling fee, so they had to accept that, and not charge me anything further.  If the surgeon's staff had done their job correctly they would have known in advance that this was not going to be covered and I could have avoided this hassle.  I was fortunate enough to have BRCA testing covered - I am adopted and have no access to family history - but Tricare now does not cover this genetic testing for anyone.  In my case a positive result would have dictated surgical options so this is important information to have.  I have also had a colonoscopy denied recently that was requested by my oncologist because I do not fit Tricare criteria for high risk.  I had a normal colonoscopy 4 years ago, prior to my breast cancer diagnosis.  The test was for screening purposes only, I have no symptoms.  My understanding is that if I present with symptoms they will approve the test.

I am a Florida resident, my treatment has been in Florida, and would be happy to speak to you further if it would be helpful.

itsjustme, if only one family member has a pre-existing condition, does it make sense to split the plans and have the family covered under a cheaper plan?

itsjustme, thanks for posting the links. Unfortunately they timed out and when I tried myself (with a random NYC zip) it only showed me a plan for catastrophic cover (no regular office visits) for about $185/mo. Regardless, I'm sorry this is the situation. I bought my own coverage for many years and definitely saw a trend where BC was (IMO) trying to move consumers to certain types of plans. At first, I chose a plan with the $1000 deductible, then a couple years later noticed that the annual premiums were much much higher than a plan with a $2500 deductible (I'd pay $2000 more a year to have a $1000 deductible vs. a $2500 deductible. Makes no sense, so I changed my plan but felt like I was  being manipulated. I hate the control that these insurance companies have.) I've never heard of premiums this high. I think the highest I've heard is $800/mo for someone with a pre-existing condition (like heart problems) and a family plan that cost something like $20,000/yr or $1666/mo. Still steep IMO but who have afford $60,000 a year? FWIW, if you are paying something that high, you may be able to take a tax-deduction for part of it.  I'd wonder if it makes sense to buy a plan with just catastrophic coverage, since that could wipe out anyone. (and if you're saving $1200/mo or $14,400/yr on premiums, that would cover quite a few office visits) Anyway, sorry to hear this and good luck.