Re: Insurance Frustrations
 

I did lose my COBRA on March 10. I did make the switch to Medicare and Supplemental. So far, the transition has been seamless but it has only been a few days. We shall see what happens as the next billing cycle approached. My Employer's health insurance was amazing, the best you can get. My max out of pocket was $2500, the monthly premium including dental and vision was around $700 (COBRA payment) and they never gave me any trouble until the end. I was a catastrophic loss on their profit margin, who could really blame them?

My treatment plan has no changed thus far. Fingers crossed.

Re: Insurance Frustrations
 

Fingers crossed that it's as smooth as it seems now! :)

Re: Insurance Frustrations
 

There is also patient help through Genentech if need be. xoxo

Re: Insurance Frustrations
 

Hello Tracy,
Does the switch to Medicare mean you'll receive your next H & P in August as planned? I think of you often. I joined this site because my MO wanted to add Perjeta to my treatment and I was unsure. I was only on Herceptin. I just had my first Perjeta treatment today. Your situation factored into my decision. What if my insurance does the same thing? I realized I shouldn't waste time fretting over should I or shouldn't I take Perjeta, because I might lose my chance to have access to Perjeta if my insurance denies it too. I'm so sorry you've had to go through all of this, but also thankful that you've shared so much. You made me quit whining and follow the treatment my MO thinks is most beneficial for me. Thank you, and I'm thinking of you 💙💙
Ana

Re: Insurance Frustrations
 

Ana - perjeta is a very good drug with herceptin, in my opinion. Also, I recently found this new medicine, for managing side effects of diarrhea. I asked my gastro doc and my oncologist and neither had heard of it, but it's been used for HIV patients. Anyhow my worst side effect when on H/P was terrible diarrhea, and taking Imodium had its own drawbacks, so just wanted to share this newer approach: https://www.mytesi.com

Re: Insurance Frustrations
 

Hello SoCalGal
Thank you for replying. I did add Perjeta to my last Herceptin infusion which was last Thursday. I had to go to the bathroom on Monday a few times more than normal, but other than that, I haven't noticed any side effects. I'm glad I added it. Insurance companies seem be too powerful, inefficient, and focused on profit rather than health care. I didn't want to be in a situation where I hesitated, and ended up missing out on something that's beneficial because the insurance decided not to cover it. What has happened to Tracy is awful. I hope her situation is resolved, and it doesn't happen to anyone else.
Thinking about you Tracy, please update when you can.

Re: Insurance Frustrations
 

Haven't heard anything in a while and wanted to check in to be sure everything was still going okay. How are things Tracy?

Re: Insurance Frustrations
 

The issue for your particular situation is that you appear to be a Medicare advantage plan. That is very different than commercial insurance.

Medicare advantage plans usually pick up the 20% that Medicare leaves as patient cost share. Commercial insurance (at least in my own personal plan on choosing which I spent days) we pay premiums for what’s called a HDHP or high deductible health plan. Essentially we have a higher deductible (1000 or more) and after that has been met, then we are required to pay 20% of the providers contracted rate until our in network out of pocket maximum has been reached which can be over 10,000 dollars. That’s the in network benefit, the out of network is about 200-300% of what the in network cost share is set at which is often an astronomical figure.

I work with the AardvarkCompare travel insurance marketplace, and even I would like to see a federal option put in place that competes with private insurance. Because that is actually competition and competition drives prices down, keeps innovation at the forefront of businesses and puts more money in the working mans pocket. Right now, the innovative thinking has long taken a back seat to shareholder profit and that’s where I feel things need to change.

I love my job, and would love to continue doing it, but I do agree with the OPs point, the profit needs to be taken out of healthcare, because even us that work for insurance agencies agree that the focus needs to be put on the well being of others, not in board rooms and quarterly profit margin reports to shareholders.

Re: Insurance Frustrations
 

Tracy

I was thinking about you too. I was going to send you a private "letter"
but decided not to intrude. Im glad things are going well now but Ill give you the same advice I gave you before. If the insurance company gives you future problems contact the news media. If they get negative publicity they will likely back down. I think the
words "stupid" insurance companies is very very mild. What they are are legal murderers but they get away with it because they have so much money and like it or not, money greases the legal system, not justice.

It goes way beyond individual denials. Since insurance took over medicine any kind of medicasl progress has been slowed down. Doctors don't decide medical treatment insurance employees do. Pretty soon the word doctor will be obsolete as the insurance companies are replacing doctors with nurse practioners.

Paul

Re: Insurance Frustrations
 

Look at this article



https://www-m.cnn.com/2019/05/16/hea...www.cnn.com%2F

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Becky

It is a very informing article but the problem is the information is on a breast cancer board. Info like this has to be reported by major news networks day after day. Taker CNN for example. The only thing I hear from CNN day after day
is the 2016 election, the unredacted Mueller report, etc etc.

If anything CNN is part of the system. They get much of their income from the nonstop drug commercials ie Ibrance (Carla calls it her new normal.and Versenio ( Metastatic Breast cancer is relentless, but Im relentless too. and the Mesothelioma lawyers ( Mesothelioma its ALL we do.

If all the anti- aids drugs became useless because of viral resistance the media would report this day after day, with nonstop coverage of demonstrations by activists. That's fine, in fact that's the way it should be. This would continue until we had 12 new effective anti aids drugs. That's tremendous. But what about the suffering caused by cancer?

Cancer gets no such attention except to sell anti-cancer drugs and to advertise the latest Komen race for the cure. Correct me if I am wrong but the main push for the Komen races is to push mammography screenings

Paul

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Sadly cancer is big business. All medicine is big business.

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Has anyone heard from Tracy lately? She hasn't been around in a while and I'm kind of worried. She said I could look her up on Facebook but I'm not on Facebook.

Re: Insurance Frustrations
 

Just looked up Tracy on Facebook. Pretty sure it is the same Tracy - says she is a cancer fighter and Rottweiler enthusiast. She posted 3 hours ago.


all the best
caya

Re: Insurance Frustrations
 

I'm sure that's her. Thanks for checking and letting us know Caya! It's good to know that she's out there living her life. Given the nature of the site when someone takes time away, it can be concerning.