Insurance change

RhondaH · 10-14-2005, 10:12 AM

Hello everyone! At work today we just got notice that as of 1/1/06 not only will our medical insurance increase 10%, BUT the carriers will also change. Not a whole lot of details as of yet, but at this point it appears that I will only have to change my primary care provider and my ob, surgeon, onc, rad onc, pediatrician for my son etc are on their acceptable list. Other than trying to find out which one (if any) will cover my Herceptin and at the best rate (I'm not even sure how to go about this as many will need pre approval...any suggestions), can any of you think of any other things I should be checking into when picking a new insurance? I would appreciate any help. Below are the choices we have. Also, if any of you have any experience with these, could you please share some insight. I was dx 2/1/05 w/ Stage 1, no node, ER/PR-, Her2+ and am on Herceptin every 3 weeks for prevention (this is how I hope to remain, but in this case I still have to plan for the "what if's"). I would appreciate any help you can give me.

Rhonda Hoffman

HMO's:

Most of our local HMO plans will be replaced by a national plan called Aetna Select

traditional medical plans:

¾ Premier Aetna Choice POS II

¾ Premier OOA (Out Of Area plan offered only when the POS II plan is not available)

¾ Basic Medical Plan

Aetna PPO (managed care plan available only in certain areas)

mts · 10-14-2005, 01:50 PM

Sounds like your employer is going through the "open enrollment" phase for employees. You might want to ensure your deductible does not go up too!

Perhaps you can call one of the doc's in the new network as well as your current doc to see if anyone else has the same Tx as you with the same ins plan. If the onc has a good billing dept; often they can figure out what their expense will be.
I don't believe the onc office can charge you differently for the Herceptin- by being in a network, they have negotiated a price for services with the carrier and you can't be charged for anything other than your deductible and "not covered" charges.

I found the customer service of my insurance to be very helpful (BC/BS of FL) and I asked for someone to become a "case manager" for me.

Anyway, during your "open enrollment" you should have representatives from your new carrier that can help you discern the best option for you. I don't trust anyone to make the decision for me. But between the two of you, the right answer should come.

My employer had the insurance cost go up too -and I work for the gov't!

By the way, I have the same Dx as you! and am on Herceptin also.
Maria

sassy · 10-14-2005, 09:05 PM

Our company had a 20% increase in rates, in part due to my treatment I am sure. (We are less than 50 members) However, we can't really complain because previously we had not had increases in 2 of 5 years and less than 5 percent 3 of 5 years. Can't make a recommendation on plans.

Sassy
________
Avandia law

uma · 10-18-2005, 12:58 PM

Rhonda,
If your employer changes Insurance companies, please check if continuity is maintained with the previous insurance company. Check any documents you need to sign with a "fine toothed comb". Some insurance companies may have small print in documents to exclude new members with pre-existing conditions, such as BC. or, they may ask for a medical exam. Insurance companies get scared if they hear the word, and try to wiggle out of their liability.

Christine · 10-18-2005, 02:12 PM

RHONDA

Picking an insurance plan can be tricky. I have always had a PPO Plan, since the Medical Linstitutions tend to require what they believe is a more acceptable plan for reimbursements. There is also a co-pay with office visits, so find if they will require initial out-of-pocket expense, and then if the Insurance will pay for all the scans you will need at 100% or 80%? Is there a total out-of-pocket expense/ year /person, that will help to pay the rest of the years medical bills at 100%? Cancer patients need the best coverage available. Hosptal expense can also be a major financial problem, so investigate for yourself and for your son. He probably be okay with the HMO FOR ROUTINE CHECK-UPS AND OTHER NEEDS FOR NOW, UNLESS HE HAS A MEDICAL CONDITION.
Check all the Brochures and go with the Insurance that seems the most adequate for you and your son separately.
I hope I helped to confuse you less.
Hugs, Christine

RhondaH · 10-19-2005, 03:11 AM

Thank you all for your responses. I used to process medical insurance claims for Travelers Insurance so I do have SOME medical claim experience, but not when it comes to CHOOSING insurance. I did do an online search using Aetna and Herceptin and actually came up with their, we in underwriting call them "position papers", and this was dated 8/05 stating that they will cover up to 1 yr of herceptin for non metastatic, node positive (this is the area that I need to fine tune as I was node negative), but it gives me hope. I will talk to my onc nurse tomorrow for her suggestions as well as the wonderful feedback I received here. Thank you again.

Rhonda Hoffman