HER2 Support Group Forums - View Single Post - can people chime in as to what insurance companies they have and what troubles

rhondalea · 10-04-2011, 05:58 AM

I don't have much to report, because I'm new at this, but as usual, it will be a long post anyway because I can't seem to shut up.

Up until the end of August, we were covered by UnitedHealthCare, which paid for the following:

Full payment for all testing requested by my doctors (but none of it was unusual). Full payment for surgery (bilateral mastectomy, even though only one breast had cancer). Noteworthy is that I was given a private room, and they paid it in full (three times the cost of the surgery itself), but then again, I was only in the hospital for one night.

Three doses of Neulasta @$20/dose, all mailed to me for self-injection at my request. (CINJ required that I come in the next day for the first dose.)

Four or five visits from the visiting nurse (can't remember exactly, and all but one visit has disappeared from my calendar). I'm pretty sure she came to see me four times after the mastectomy to check on how I was doing, and then she was required to supervise me for the first Neulasta shot I gave myself at home.

For the month of August, I was also covered by Empire BC/BS, but none of that month's claims were submitted to them. (My husband changed jobs, his old employer terminated coverage on 7/29, not 7/31, and the new cards came late in the month, so I COBRA'd UHC for one month and two days, because I didn't want to deal with all the paper it would have entailed otherwise.

Since then, Empire seems to be paying all claims submitted, and prescription copays are slightly less expensive so far, but when I needed an inhaler on the spur of the moment (for Taxol reaction), they declined to pay because they considered it maintenance and wanted it sent to Caremark. My internist had also prescribed an inhaler for exercise-induced asthma (which I'd lost somewhere in the house because I wasn't using it, or there'd have been no need for the new one), and a non-existent relationship was assumed. I could've argued--and I will eventually ask about it--but the pharmacy's discount ended up being the same as the normal UHC copay for albuterol ($40), so I didn't bother.

I will report further if there are issues or if Empire goes above and beyond the call of duty.

10-04-2011, 05:58 AM	#9
rhondalea Senior Member Join Date: Jun 2011 Location: Somerset, NJ Posts: 487	Re: can people chime in as to what insurance companies they have and what troubles I don't have much to report, because I'm new at this, but as usual, it will be a long post anyway because I can't seem to shut up. Up until the end of August, we were covered by UnitedHealthCare, which paid for the following: Full payment for all testing requested by my doctors (but none of it was unusual). Full payment for surgery (bilateral mastectomy, even though only one breast had cancer). Noteworthy is that I was given a private room, and they paid it in full (three times the cost of the surgery itself), but then again, I was only in the hospital for one night. Three doses of Neulasta @$20/dose, all mailed to me for self-injection at my request. (CINJ required that I come in the next day for the first dose.) Four or five visits from the visiting nurse (can't remember exactly, and all but one visit has disappeared from my calendar). I'm pretty sure she came to see me four times after the mastectomy to check on how I was doing, and then she was required to supervise me for the first Neulasta shot I gave myself at home. For the month of August, I was also covered by Empire BC/BS, but none of that month's claims were submitted to them. (My husband changed jobs, his old employer terminated coverage on 7/29, not 7/31, and the new cards came late in the month, so I COBRA'd UHC for one month and two days, because I didn't want to deal with all the paper it would have entailed otherwise. Since then, Empire seems to be paying all claims submitted, and prescription copays are slightly less expensive so far, but when I needed an inhaler on the spur of the moment (for Taxol reaction), they declined to pay because they considered it maintenance and wanted it sent to Caremark. My internist had also prescribed an inhaler for exercise-induced asthma (which I'd lost somewhere in the house because I wasn't using it, or there'd have been no need for the new one), and a non-existent relationship was assumed. I could've argued--and I will eventually ask about it--but the pharmacy's discount ended up being the same as the normal UHC copay for albuterol ($40), so I didn't bother. I will report further if there are issues or if Empire goes above and beyond the call of duty.