HER2 Support Group Forums - View Single Post - Getting HOSED by my health plan

StephN · 03-27-2011, 07:58 PM

Hello everyone -

Well, after riding along pretty well since going on disability and rolling my old health plan into a "med-advantage" plan, I am getting knicked but good.

Last year they nearly doubled my premiums, but not much else changed. This year the premiums went down by $50/month, but a bunch of "coinsurance" kicked in with lowered covered percentages on things like scans, where I have to make up the difference.

Scans so far is the BIG one for me. They are only covered now at 80%. Does not matter what kind of scan it is, what it is for or who orders it. Does not matter if the scan is for monitoring cancer or not. I have to pay 20% of the BILLED amount to the center where I have the scan.

If I was in treatment for active mets and having more frequent scans, I would go broke! How are the others out there dealing with this?

This seems to be the insurance company's answer to the comprehensive health bill of 2 years ago. I have complained, but am told I have the option of looking for another coverage during the open enrollment later in the year.

03-27-2011, 07:58 PM	#1
StephN Senior Member Join Date: Nov 2004 Location: Misty woods of WA State Posts: 4,128	Getting HOSED by my health plan - anyone else? Hello everyone - Well, after riding along pretty well since going on disability and rolling my old health plan into a "med-advantage" plan, I am getting knicked but good. Last year they nearly doubled my premiums, but not much else changed. This year the premiums went down by $50/month, but a bunch of "coinsurance" kicked in with lowered covered percentages on things like scans, where I have to make up the difference. Scans so far is the BIG one for me. They are only covered now at 80%. Does not matter what kind of scan it is, what it is for or who orders it. Does not matter if the scan is for monitoring cancer or not. I have to pay 20% of the BILLED amount to the center where I have the scan. If I was in treatment for active mets and having more frequent scans, I would go broke! How are the others out there dealing with this? This seems to be the insurance company's answer to the comprehensive health bill of 2 years ago. I have complained, but am told I have the option of looking for another coverage during the open enrollment later in the year. __________________ "When I hear music, I fear no danger. I am invulnerable. I see no foe. I am related to the earliest times, and to the latest." H.D. Thoreau Live in the moment. MY STORY SO FAR ~~~~ Found suspicious lump 9/2000 Lumpectomy, then node dissection and port placement Stage IIB, 8 pos nodes of 18, Grade 3, ER & PR - Adriamycin 12 weekly, taxotere 4 rounds 36 rads - very little burning 3 mos after rads liver full of tumors, Stage IV Jan 2002, one spot on sternum Weekly Taxol, Navelbine, Herceptin for 27 rounds to NED! 2003 & 2004 no active disease - 3 weekly Herceptin + Zometa Jan 2005 two mets to brain - Gamma Knife on Jan 18 All clear until treated cerebellum spot showing activity on Jan 2006 brain MRI & brain PET Brain surgery on Feb 9, 2006 - no cancer, 100% radiation necrosis - tumor was still dying Continue as NED while on Herceptin & quarterly Zometa Fall-2006 - off Zometa - watching one small brain spot (scar?) 2007 - spot/scar in brain stable - finished anticoagulation therapy for clot along my port-a-catheter - 3 angioplasties to unblock vena cava 2008 - Brain and body still NED! Port removed and scans in Dec. Dec 2008 - stop Herceptin - Vaccine Trial at U of W begun in Oct. of 2011 STILL NED everywhere in Feb 2014 - on wing & prayer 7/14 - Started twice yearly Zometa for my bones Jan. 2015 checkup still shows NED 2015 Neuropathy in feet - otherwise all OK - still NED. Same news for 2016 and all of 2017. Nov of 2017 - had small skin cancer removed from my face. Will have Zometa end of Jan. 2018.