Insurance deductible and max out of pocket

DestrehanMom · October 2017

I was told by my insurance company, BlueCross/BlueShield of La. today that my deductible and max out of pocket will re-set on Jan 1 even though I will be receiving treatment for the Breast Cancer diagnosed in 2017 for which I have already met the deductible and max out of pocket. That seems cruel and unfair to need to pay two deductibles and have to meet two max out of pocket levels because my cancer was detected at the end of the year. Is there an argument to be made?

finallyoverit · October 2017

Unfortunately, no. I've been through the same situation twice.

labelle · October 2017

BTDT. Definitely sucks, but that's how it works.

exbrnxgrl · October 2017

Sadly, annual deductibles and out of pocket expenses follow a set calendar, regardless of one's illness. That is something you should have been told when you signed up for your plan, but it's fairly standard practice and has been for many, many years

Castigame · October 2017

well cancer keeps on giving. Lucky for me bc blew up in Jan of this year. Done w all treatments and all the optional surgeries done this year. Colonoscopy endoscopy orthopedic surgery hystrectomy hear chk up etc. Looking for anything else I should be doing.

This year does not mean anything bc on 02/20/18 ct scan and dexa scan scheduled. That will be enough to meet ded and out of pocket max for 2018. Time to go get another credit card w 0 APR promotion. And repeat 2019 and on to stay alive.

Denise-G · October 2017

No argument, I had the same experience. My high deductibles continue as do now even higher insurance premiums.

It is all so hard.

Because of all the things I learned through my own BC treatment, when my sister was diagnosed with BC, she also had the same issues with insurance. She went and talked to her major university medical center. They gave her a grant or stipend - forget what they called it - and paid her deductible and out-of-pocket for THREE YEARS. It was a major gift, obviously. Normally, they would not give it to an out-of-state patient, but since she had genetic reasons for BC, they made an exception.

Worth a try to talk to your hospital.

gb2115 · October 2017

That happened to me also with an October 2016 dx. I met OOP max for 2016, then did it again by FEBRUARY 2017 thanks to radiation. I have been enjoying free healthcare since then but it will end with the new year.

So yeah it sucks but there's no argument against it, it's how insurance works.

edwards750 · November 2017

That’s the way Insurance has always worked. We have BC/BS of Tennessee. Our deductible is $5k. We met our deductible in 3 months! I was DX in 2011. It took several years to pay off some of the bills associated with BC but the good thing was when we did meet our deductible we were 100% so my 33 radiation treatments were on them. Idk how we could have afforded them. Also my colonoscopy and Oncologist appointment were also covered by that time. That’s why we try to schedule costly procedures at the end of the year if possible. I know it’s not realistic with a BC DX.

You can always appeal with BC but frankly it’s a lost cause. It’s how they do business. Think about what that would cost them. Zero chance.

I would check and see if you can make payments if necessary. We did. Just a thought.

Diane

calidancer · November 2017

So frustrating. I just had a revision for capsular contracture and in less than a month feeling so much tightness that I am very concerned it's contracting again, already. Looked at my insurance online yesterday. Hospital billed $63,000 for the surgery not including surgeon or anestheseologist (I did have to go under a second time and sleep over unexpectedly due to a "hematoma" ie bleed). The revision will cost me over $10,000 for ONE side. I had to pay my PS out of pocket because she no longer takes any BC/BS and they wouldn't approve a continuation of coverage. I thought the hospital would be a couple thousand, but no, it's close to seven. Can't imagine doing this again in December or any other procedures this year-- I gotta go to work to pay this one off!!! So there's no way I'll even get this implant out even if it's up at my collarbone, painful, or ruptured like the last one turned out to be.

I feel you, it's so unfair. These surgeries are mandated to be "covered" but what's covered if you have to pay $10k????

We need single payer. NOW.

edwards750 · November 2017

I know we are all in sticker shock when we get the bills for our procedures. We do have BC/BS but a large deductible. Meds are off the chart too(no pun intended)

I can’t imagine how people pay these enormous bills even with insurance. Making monthly payments certainly helps but what would a monthly payment be with a balance like $10k? Plus the doctors want a healthy monthly payment and refuse to accept less. I paid what I could and dared them to force me to do otherwise. They didn’t but they did their best to humiliate me in the process like we were paupers. And what do people possibly do who don’t have health insurance? Turned away?

We appealed a decision by BC because they were charging us OON. We won our appeal and should have. It meant a $5k savings.

Nowadays you have to make sure your doctor, facility, anesthesiologist and lab are all in network. How can you possible control all of that? We were charged a $3k facility fee but managed to challenge and win that battle too thankfully.

Diane

Castigame · November 2017

so I heard sisters saying don't pay any bill wo EOB issued by your insurance company. Insurance Co EOB stmts could be wrong. I did not scrutinize EOB obviously. I just delayed pymts as much as possible. Approx $7000.00 in collection (two biggest bills) Now I am done w all the surgeries. I have had more time to look at paperwork and saw above.

Called up my insurance co and asked "YTD OOP appiled is $6800 plus vs Max per my policy is $4800. This means I overpaid it, right?" The rep acknowledged the excesss and promised correction. I was able to tell her which bills caused the excess. There are 201 claims for me YTD. Probably 20 will be added before yr end. Due to the sheer quantity of claims, insurance com just accepted wrong invoice wo checking its accuracy. I am so glad I found. It made me feel victorious. Also, this means significant reduction of outstanding bill before Xmas and going back to work next yr.

Lesson learned here is no body is perfect including those who benefited you big time in this case insurance company who saved my life by paying $250,000.

NancyHB · November 2017

Diane, you asked what happens to those without insurance - my MOs office says that yes, in some cases, they are turned away. The navigators and social workers will do everything in their power to help, but some people fall between the cracks - make too much to qualify for Medicaid and Uncompensated Care (our hospital's "charity care”), but not enough to afforded health insurance or the out-of-pocket expenses. My NP says she’s seen it happen - and my heart breaks. Some spend the rest of their life paying for care; others lose their home, some file bankruptcy. It’s unconscionable that life-saving medical care is a business. Eventually, only the wealthy will be able to afford care; the rest of us will just...not

TWills · November 2017

I'll likely have 4 years of deductible and max out of pocket $.

2016 Nov/Dec Diagnosed and BMX.

2017 Chemo, expander placement, rads, failed expander.

2018 Reconstruction spring or summer.

2019 Likley reconstruction revisions.

Stinks but it's standard. Cancer is expensive.

Sitti · November 2017

Anyone else's premiums out of sight? We are paying almost $1000 per month health insurance premium, told it's going to almost $1300 per month in January. (Husband works for small company) Is this normal now? It's not like we have a low out of pocket either.

Castigame · November 2017

sitti,

That is obsurd!!! We pay $216 per mo. Ded is 3200 OOP is 4800. Honestly your hubbys employer is tad bit crooked bc you can find better under ACA. DH had an employer like that few yrs ago who kept deducting almost $500.00 every month despite protest. The outrageous prem alone was enough reason for DH to get a new job.

Twills,

Did you go to Moffit by any chance? I did for BMX and chemos. Yes I am on the hook for ded and oop for the next 5 yrs. I even know the exact date the total bill will be generated bc getting a couple of fancy scans, blood tests and MO ckup.

On a related note, I just want to make sure ladies know about $1 per pill Arimidex (brand name no income requirement no insurance involved) as wells as Novarits issued Femara co pay card (up to $12000.00 per yr subsidy. Call 855-748-2655 which is eagle pharmacy who is the service provider for arimidex direct. WWW.ARIMIDEXDIRECT.COM For Femara copay card just google it. A few more simple steps, you should be able to print out the card w your name.

I was going to get a new Mercedes (mid life crisis)but $8000 per yr times 5 probably means the earliest I can get one is 2023. Damned it BC continues to crimp my style.

MelissaDallas · November 2017

Castigame, as to "absurdity" it entirely depends on where you live as to what is available and the costs. It doesn't mean the employer is "crooked." I don't qualify for a subsidy, and mine will be close to $800 a month just for me, with a 6,000.00 or higher deductible.

DodgersGirl · November 2017

Sitti, my insurance thru employer is $860 s month and hubby's employer insurance was $650 a month. (We are both retired so we can continue with the insurance but our employers no longer pay the premiums)

Insurance is expensive. But really glad 😁 have it with the medical bills incurred in 2017.

wrenn · November 2017

I am so grateful to never have had to think about cost with my cancer. Money never entered my mind. I can't imagine dealing with that stress along with the rest of the nightmare.

So sorry you are having to deal with this. It isn't fair.

Lula73 · November 2017

If you get your insurance through your employer many things affect how much your premium will be: what level of coverage is offered, is it an indemnity plan (often accompanied by an hsa card funded by employer)/hmo/ppo, ho high/low the deductible and/or out of pocket maximum is, does it include dental/vision/mental health benefits, what percentage of the premium cost is being covered by the employer, how many employees are there and are all employees paying the same percentage of premium to name the big ones. Under ACA, premium depends on the state, the insurance companies that are offering ACA, level of coverage, how High/low the deductible and/or out of pocket maximum is, if out of network care is offered, is it an hmo or ppo plan, and whether or not you qualify for any subsidies.

Insurance deductible and max out of pocket

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