Issurance Issues – Knowledge is power!
I started writing this with so much angry inside that I had to take a hot shower. Now I know that if I can help just one person on these boards it is all worthwhile. I am one of those people that believe EVERYTHING happens for a reason… good and bad. So here goes my tale…. Its called color me naïve. <O:p</O:p
IN the past two weeks I have begun chemo. The first appt I got the “talk” about how we treat the total person, physically, mentally, emotionally and financially. That being said, someone was to call me in the week to follow to discuss insurance issues. I have one of the many Personal choice IBX plans. I was told that day that my insurance covers 80% of chemo.. Silly me, did not ask for something even close to a ball park figure… in my book I will not put a price tag on treatment… I only know that I want to survive. <O:p</O:p
Chemo day came and again I got the talk and was advised again about the 80/20 that I would have to endure. They have a program that will display your insurance policy at the touch of a key. It was mentioned that MAYBE the hospital could absorb some of the cost, they were a private (IN NETWORK I need to add) cancer center only “associated” with the hospital.<O:p</O:p
After doing some homework, I discovered that my insurance would pay the same in or out of the cancer center or the hospital. <O:p</O:p
Again I called the business office of my center and was told I could not afford the cost of treatment! It was at this point in time that I asked how much the charges were for that first day. She could not tell me until IBX paid the claim? SO I went on line to see my IBX account and please imagine the look on my face when I saw a 5 figure amount not starting with a 1. I called back and asked her about all the individual charges. What was told to me was that much of that would be written off due to “contracted prices” that my insurance company had agreed to pay. OK but I am still hearing that I will be responsible for the 20%. Still being told that I still would be racking up untold dollars with the unpaid 20% portion.<O:p</O:p
I recognized that I had a financial responsibility and was willing to have a payment plan. <O:p</O:p
My next call was to confirm my next chemo appt . I opted to continue having the regiment in the cancer center and not the hospital because it is a difference of spending the entire day there vs 41/2 hors there, especially since the cost and payment to all involved did not change. They had already switched me to the hospital! I said no, I want to continue being treated at the cancer center because I have ALREADY TAKEN CARE OF THE FINANCIAL END OF ALL OF THIS. <O:p
Asked how, I then brought to their attention the portion of my policy that states that I have an OUT OF POCKET MAXIMUM.(annual) This means that after I have paid in my case the amount equal to that of a pimple on an elephants butt… the insurance company picks up 100% of the contracted charges. Having been through surgery, and radiation my out of pocket expenses have already been met and they didn’t see this? All procedures had been with the associated hospital. No questions had been asked to me concerning other procedures. Why did they not know to bring this to my attention? I must have been frantic for about 3 hours until I learned this… even in tears! Some insurance companies do have a lifetime maximum, hopefully all this information helps.<O:p</O:p
How to circumvent what I went through today- <O:p</O:p
First and foremost read your insurance policy. If you are covered by a work policy, talk to your HR department benefits administrator. She was my knight in shining armor. Secondly, down load this book (free). That is where I learned about “out of pocket”.
http://www.pabreastcancer.org/insurance_book.pdf<O:p</O:p
BREAST CANCER COVERED OR NOT? An insurance guide. <O:p</O:p
And last but not least talk to your hospital social worker, if they do not know the answer they will guide you to people that do. Whether you have insurance or not there are people that can help guide and direct you. Unfortunately this is not the time you want to have to go through the horse and pony show.<O:p</O:p
If I can help just one person by telling my color me naïve story then it has been worth it.<O:p</O:p
Hugs and prayers to all<O:p</O:p
Melinda<O:p</O:p
<O:p
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