Insurance woes

Bear with me while I burden you.

I just received a letter from Aetna, the insurance company we were about to pay an increased monthly premium of $760 to which states that my hospital is dropping Aetna.

For me that means not ONLY the hospital (which has an amazing Cancer Wing), but also my chemo treatment center, my onc, my family doctor, my radiation treatment center, the place I go for scans and anything else you can think of in our healing package.

We CAN, however, continue with Aetna out-of network to the tune of $760/mo premium, $4,600 deductible and 70% of all bills after the deductible. No more co-pays, etc.

My assumption is that Aetna has lowered the amount they pay the hospital to the point where the hospital is fighting back. But I don't know what I'll do.

Battle plan: 1. Talk to the Chemo Center financial director. Then, if necessary, the Exec. Dir., who I met a few weeks ago during treatment.
2. Talk to my former pharmacist, a hospital Director.
3. Talk to the hospital administrator (probably a waste of time).
4. Talk to the prominent physicans on my team.
5. If all else fails, talk to the Boulder newspaper and the Denver TV station. Hey, I'm sure both the hospital and Aetna would LOVE a little free publicity.

If all this fails (and there's a May 25 deadline), my husband is considering finding another job with insurance the hospital DOES cover. But who's to say that XYZ insurance Co. isn't next?

Am surprised to find myself in this situation. But thanks for "listening."

Love and light,

Lisa

My Heart goes out to you lisa, I wish I could help in some way. Somehow, this seems bordering on criminal.
Hang-in,
Al

I found this website, here is the insurance from a Doctor's point of view.


Regards
Joe


Medical Insurance Woes


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Dear Lisa
I agree with Al. You do not need this worry.It is so unfair. You seem to have a plan of what to try already which is so like you. I hope others can help with advice - I don't really understand the American insurance system.
Keep up posted.
love
lindaw

Thanks for the support.

Linda, many of us don't understand it either. Or rather we don't understand why our government doesn't help us. Insurance companies here are being allowed to run the entire medical system. Doctors can't afford to practice on their own and situations like this are happening more and more frequently. I'm sure the insurance companies' profits aren't hurting a bit.

Love and light,

Lisa

I am sorry for your troubles. Lord knows we all have enough on our minds. I switched from Aetna's HMO to United Healthcare PPO. Many of the doctors that were recommended were not on Aetna's plan and the referrals were too often for me. My company offered options- can your husband speak to his employer? I may be laid off in the fall so I found out that Starbucks offers health benefits with just p/t work as do many banks. I have felt like my back is against the wall a lot with this disease and I am sure that is what you are feeling right now.

[Lolly]

Dear Lisa, I am so sorry you are having to deal with this extra anxiety. I don't know if this will help, but if you decide to change insurance companies, check into whether your state has a medical insurance pool for high risk patients, and whether your health care providers are in the network. I'm in the high risk pool in our state; it's managed by Blue Cross and although premiums are higher than non-high risk groups, most care providers are in their network. I think you have a good case for "continuity of care", and I would also consider calling your state's insurance ombudsman, if that's the right title.
Keeping you in my thoughts and prayers for strength and courage.

<3,
Lolly

Lisa - so sorry you are dealing with this, but remember you need to live a stress free life now - Ha! During our separation, in the mist of my treatments (the first time around), my dear hubby quit his job (because he couldn't smoke there anymore). He refused the COBRA without telling me -leaving me, my children and his son from another relationship without medical coverage. Sweet huh? Anyway - I called social services and was able to get Family Health Plus for me and Child Health Plus for the kids (New York State low income coverage). We were all covered by Blue Cross Blue Shield through the program with no premiums and no co-pays. Contact Social Services in your area and see what programs they may have to offer. Fill out every application - the worst that can happen is that you get denied. I am no longer eligible for that program for myself (kids still have free coverage). I now have Medicare as my primary and Medicaid as my secondary. I do not have prescription coverage so I searched the Internet for ways to get free med's. Together RX gets me discounts on certain drugs - Novartis (Femara) charges me $12 for any of their drugs. I was paying $246 a month with the Medicare discount card - some discount. I have found ways to get most of my med's cheap or free and Cancer Care reimburses for pain med's. Good luck.

Lisa
I know how you feel, I too am forced to go elsewhere for treatment due to the hospital doubling the price of Herceptin..I have the Dr. and chemo nurses fighting for me, but the hosp. won't budge on their charges. The Dr said the only thing I could do is use up all my insurance and they would file an appeal with the insurance due to catastrophic illness...if that failed, I guess it would be sell everything..so, yesterday when I got home, I began looking for a new oncologist...not where I want to be at this stage of the game......
Hugs

Sheila

Ouch! I have Aetna too, so this is making me nervous.

We just switched from EPO to Open Access at the start of 2005. EPO requires referrals from primary doctor, which is a PAIN in the NECK; Open means we could select anybody, as long as they are in-network providers. Hence, a higher monthly premium...

Plus, Open does not offer a limited max cap, so maybe this is why Aetna is having problems????.... I hope this is just a rumor, so that Aetna is NOT having any issues!

Lisa
Your plan sounds great to me, and it would be an interesting human interest story that should get their attention. Hope your efforts are successful. Your payments are high and show your intention to stay with this med group and center. I absolutely feel you have a case, especially since you have been with them for 7 yrs. Let me know your progress.

My warmest wishes, hugs Christine

Hi Lisa,
I found this mission on the pages of the National Cancer Inst. as a service goal:

Medically underserved audiences include older Americans and individuals living in communities lacking adequate health services or experiencing language, educational, financial, or transportation barriers.

The link is:

http://cis.nci.nih.gov/community/community.html

The main office of the CIS Rocky Mountain Region is located at Penrose-St. Francis Health Systems.

Address: Centura Health
Penrose-St. Francis Health Services
P.O. Box 7021
Colorado Springs, CO 80933

Phone: 719–776–3150
Fax: 719–776–3132


I also found this link which may be helpful explaining many, many options:

http://www.cancer.org/docroot/MLT/content/...tearea=&level=1

Also, Getting into a clinical trial may help because they often cover full drug and diagnostic costs.
Getting a compasionate use drug from the manufacturer,

If all else fails, get a temporary separation from your husband and claim dire need from the State Services.

Good luck with this and again, I can't imagine the stress this is causing you; all that money going overseas on the backs of the sick? Go figure!

One last thought, do you have any relatives in Canada that you can go visit?

Let us know how you make out and good luck!!!!!
Al

Lisa, Don't give up. You can file an appeal and state that you are already under the care of this facility and these doctors. You can request in your appeal that you continue the same with the same coverage. You may also have an insurance commisioner in your state. The state of WV has one, tax paid position and they are great about getting involved. You have a right to an appeal and the insurance company must give you all the step for the appeal process. I worked for an insurance company and if you need help with your appeal, email me and I will help in any way I can.
Good luck.
Peace,
Sherry

Jojo,

Any idea if Open Access allows for all tests, including PETS?

Love and light,

Lisa

[StephN]

Lisa -
I hope you are finding some solution to the MAJOR kink the rope by the insurance problems.
Changing jobs would not be the worst idea if all others fail. I know your hubby would walk on his hands to the ends of the earth for you!

I have always paid more than most to have good coverage - a little birdie kept telling me that I needed this more than a new kitchen, more shoes, etc. Glad I listened!

Let us know how it goes.