can people chime in as to what insurance companies they have and what troubles

Lani · 10-03-2011, 11:06 AM

they do/ don't have getting them to cover IV meds, oral meds, scans, MRIs etc

In light of blue shield of California's decision to stop covering avastin for breat cancer, gathering this information and dispersing it seems all the more essential.

Let's try to make a paper trail so those whose employers offer a smorgasbord of insurance choices or a change of insurance in January can have a feel for which insurance companies have been naughty or nice!

May be a great way to try to get some accountability/ compare what is usually difficult to compare.

May help get companies to cover oral meds like lapatinib when they realize what their competitors do/don't do. I know it might depend on which of thousands of different policy types of any one insurance company one might have, but still thought this might be useful.

Having great info doesn't help if you can't get insurance company to pay for
treatment...

Thanks in advance to all who contribute.

Laurel · 10-03-2011, 05:38 PM

During chemo I had Capital Blue Cross, now we are with Highmark Blue Shield. Captital B.C. was wonderful. They even permitted Curascript to mail me 2 neulasta injections per month to my home to be kept in my refrigerator until needed after each round of chemo. Those cost 3k per injection. I self administered them and I guess they felt I saved a trip back to the infusion room, so cost them less. I was denied nothing during treatment and my reconstruction. Thus far Highmark has been ok, too. I am in Pennsylvania.

hutchibk · 10-03-2011, 07:25 PM

The first half of my treatments (3 years) I was on Blue Cross Blue Shield of Texas, PPO. They were stellar and covered everything except Tykerb, as it fell under prescription and not medical chemo. GSK provided it for next to free to me once I completed the financial hardship paperwork. I never had any problem with BCBS beyond that.

The second half of my treatments (the last 4 years), I have been on Medicare. Within 4 months of being enrolled, my imaging center was denied payment for two brain MRIs, which I subsequently had to negotiate to pay the imaging center for a percentage of. In more recent years, my radiation oncologist has been denied payment for approximately 1/3 of the treatments he has given me for the 6 brain mets that he treated. After the 4 appeal limit, they stuck to their guns and said he essentially "overtreated me" with more fractions than their published guidelines call for, and flat out denied paying him. I am not to be held responsible for the unpaid amount. Who do you think I trust, my physicist radiation oncologist or cost ratio Medicare guidelines? He continues to treat me as he sees fit. I have apologized to him that I made such a grievous error in judgment when I signed on to Medicare as a disability patient.

Pray · 10-03-2011, 09:29 PM

I have had Cigna Health Alliance Plan (HAP) PPO. It has covered everything so far including 4 reconstruction surgeries (so far). We have been very happy with it, we do have to pay $2000 in deduct. and $2000. in copays for each year.

Unfortunately My Husbands work is switching to Blue Cross Blue Shield next year! We are very worried what they will cover.

BonnieR · 10-03-2011, 10:36 PM

Pray, my husband's big national employer has a plan through BC/BS of Illinois. They have been wonderful, never denied anything. Even covered the Oncotype test. Of course every plan is different depending on the deal arranged between the employer and the insurer. I hope yours turns out favorably.
Keep the faith

pibikay · 10-04-2011, 04:03 AM

I wish we have some options here.I have New India Assurances's mediclaim.Only later we came to know it covers only hospitalisation.So tykerb and xeloda are out.There are no companies here accepting fresh policies for cancer survivors.If any one in this group has any link with any insurance in India which accepts such policies we will be very very gratefull

sarah · 10-04-2011, 05:25 AM

Here in France, the sicker you are the more the coverage, if you have cancer, everything for it is paid for 100% including taxis to treatment and all prescriptions, physical therapy, etc. However trials are a little different and I'm not sure what outside of the trial is covered. As long as my oncologist felt I needed Herceptin and Femara, I got it and he consulted me about going off it. We decided together and I delayed going off it for over 1 year. I get a Petscan and numerous other tests free every year. We pay into the universal health system as does everyone in France. We all love it!!! no hassles. It's considered a right in France not a luxury.
It pains me when I hear people fighting about their insurance and reminds me when I was diagnosed the first time and I called my excellent Californian health insure provider to let them know, I ended up in tears and hysterical and my husband forbade me to ever speak to them again and jsut asked me to tell what doctors I wanted and which hospital and he fought the fight. I believe it cost us out of pocket an extra $20,000. luckily we were both working back then and it didn't totally cripple us. It's not the reason we moved to France - I was told I was cured!!! but since I did get sick again, I'm really glad I was here and the hospitals are clean, the nurses so sweet, you are really indulged - they have people come around and give you massages, manicures, make-up and psychologists and nutritionists if you want it and being France you're offered wine with meals!!! I told them I didn't think it went with chemo!!!
oh and the cost to the French government is half what the US government pays out for medical costs!!! interesting, n'est-ce pas??? People rarely go to the emergency ward here - only in traffic accidents etc. You pay a GP 22 euro (about $29) per visit and you get back 16 euro if you're in the system. So the GP treats most problems instead of you having to rush off to emergency. My oncologist (world renown, speaks at ASCO, etc) I pay 80 euro and get back 40.
Americans pay less in taxes, the French pay more but their health system is fairer, their roads and trains are great, so it's a question of priorities and lifestyle.

sarah · 10-04-2011, 05:34 AM

Remember the US Health Insurance companies are in business to make money and honestly if you're too ill, they'd just as soon you died.
In France, the health system is only there to keep you well, not to make a profit.
That's why there's a top limit in what the US health insurers are willing to pay, yes it's high but.....

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.

Pray · 10-04-2011, 06:08 AM

Hi Bonnie,

Thank you for your post! I do hope I'm as fortunate as you have been on BC BS! We are hoping to get the packages and prices soon so as to go over them all and get the best deal.

You are good to me and I appreciate you so!

Your Friend,

Nancy

NEDenise · 10-04-2011, 07:04 AM

Hi all!
Like Rhonda, I'm relatively new to the whole survivor thing, but so far BC/BS (Personal Choice PPO) has paid for everything. I do have to pay a co-pay when I see the onc, but nothing for tests, infusion, bloodwork.
Not sure what the copay will be for surgery this time, but last time, I think it was $75. May be different this time because I'm an in-patient, not an out-patient.
They also sent my neulasta injections by special messenger to my home each time for self injection.
I've been very happy so far...hope the good feelings continue!
Good thread, Lani!
Stay Strong Everyone!
Denise
PS- just remembered... my BC/BS does pay for bras, but does not pay for wigs

Sheila · 10-04-2011, 10:22 AM

I have BC BS of Illinois PPO through my husband, and my hospital is a PPO. I have never paid for chemo, hospital bills including surgery, or oncology visits. We do have a higher deductible this year than we have ever had, but still they have been great. They paid for mastectomy bras, prosthesis, swim suits, swim prosthesis, yearly wigs and lymphedema sleeves every 3 months. They truly have been a godsend, without having the added stress of medical bills.

Our prescription plan is not so good. Neulasta shots are rationed and sent the day I need them, as are Neupogen...they cost me 30.00 ea. Trying to get prescriptions filled is somewhat of a nightmare...this is all new since the company switched to Curascripts....we never had this problem with Caremark....although I did have a time with them getting Tykerb.

My sister has BC BS of IL PPO also and hers would not cover Cranial Prosthesis (Wigs) but she has no copay on the Neulasta. All in all, I think the insurance we have through BC BS of IL is phenomenal...considering the thousands of dollars a month that my bills add up to....I am well over the 3 million dollar mark in 10 years...truly feel blessed that my husbands insurance is so good. They told me as long as I continue to use a PPO provider, there is no lifetime maximum. Good thing, because I plan to be around for a lot longer!

Jackie07 · 10-04-2011, 11:11 AM

My husband made a mistake listening to a clerk (on the phone) assuring him that we were covered by the new plan with our hospital. So hubby refused to pay our Dec. premium to BCBS - he and I actually had a 'battle' in between our living room and the driveway where the mailbox is located. We ended up owing $5000 just for that month.

I've set up a auto-draft monthly payment plan for the amount we owe. Yesterday I contacted the health plan to see if there is a 'lum-sum' discout if we just pay it off. To my surprise I was told there's another $4000.00 + bill from 2007 when BCBS and my hospital health plan severed their partnership.

"Sixteen tons and what do you get? Another day older and deeper in debt. St. Peter don’t you call me cause I can’t go – I owe my soul to the company store…” http://www.youtube.com/watch?v=Joo90ZWrUkU

BonnieR · 10-04-2011, 11:43 AM

Jackie, I can identify with you. We got long term care insurance when it was first offered by my husband's company at a good rate. Recently, I commented on how pleased I was to have it since we have no children or nearby family. Especially since getting cancer. Well, he tells me he cancelled it because of cost! I was furious that he did not consult with me. Turns out we DO still have it because I guess he failed to cancel properly. lol
He is a dear man and is the most supportive spouse one could ever want. But he has his lapses....

Soccermom · 10-04-2011, 08:24 PM

No problems...NO insurance! :0

Lori R · 10-05-2011, 05:47 AM

This is a very insightful thread and I appreciate everyone's feedback.

I have continued to work full time (a very supportive company and manager) and do so because I am the primary insurance provider for my family.

I work for a corporation that is self funded and uses Cigna to manage their claims. My insurance has been wonderful.

While I must pay the $2500 a year deductible, that is my most significant expense. I believe that is reasonable as I have been on herceptin for 4 years and have had multiple surgeries. Much to my surprise, insurance has covered new breast forms, bras, and a wig a year.

When my onc suggested a Herceptin+Tykerb regime, I was concerned. Although insurance denied, my Dr. quickly appealed and insurance subsequently approved. I was able to receive the drugs within 3 weeks.

So....I have every incentive to stay active, upbeat and continue to work.

chekmark · 10-07-2011, 05:45 PM

I have great insurance. I have $150.00 deductible and then everything is paid at 100%. Since this has all started I have paid around $220.00 - $250.00 out of pocket with my $10.00 copay and deductible. I have Medical Mutual of Ohio. My reconstruction was approved immediatley and also allowing augmentation on the other side for symmetry. Haven't had that yet. I pay $5.00 for almost all of my prescriptions. My husband is a teacher and I am so thankful for his great insurance. Before bc I would have my annual mammo and ob gyn appts so I am sure that his insurance company is hating me right now. I have never had to call them about anything, it has all been taken care of. One less stress for me. Now the big question, did all the treatment they paid for work? Time will tell. Good luck everyone and god bless. Darlene

anna4969 · 10-08-2011, 04:58 PM

What a great thread you have started. It is very interesting to know what others have to deal with regarding insurance. I have United Health Care and we have a $8000 yearly out of pocket max that must be met. Yes, I said $8000.00. This Janurary will be our 3rd year of gathering together $8000 dollars to pay for treatments, scans, surgery, etc. Now once we have paid the $8000, everything is covered 100%. But still...They have never given me grief about chemo or surgery or scans, but what they did give me grief about was they would not pay for a wig and when I developed lymphedema this spring they would not pay for a compression sleeve until I pulled out the "Women's Cancer Right Act of 1998" card. Then they paid. I have the DIEP coming up in November and am just waiting and praying that they will not give me any trouble there. Yes, needless to say, it is stressful to have this hanging over our heads nonstop. I am thankful we do have insurance as I would not be here today, I'm sure.

Yorkiegirl · 10-08-2011, 05:55 PM

Hubby Retired from the Army at the end of 2004 ( I was Dx'd March 2005) and the best thing we ever did was to continue our Military Insurance. We have TriCare and they paid for every thing.Not ever one single problem. My Co Pays are $12.00 and Rx's are either $3.00 or $9.00. We have no deductable at all.

fauxgypsy · 10-09-2011, 06:57 PM

When I was first diagnosed I was put on Mississippi Medicaid through the Breast and Cervical Cancer Screening program. I was self employed and had not been able to get insurance. I was able to get the care I needed. Now I am an employee of the great state of Mississippi and the state plan is administered through Blue Cross. I have been fighting with them for almost a year to get them to pay for a PET scan. At this point I am going to file a complaint with the State Insurance Commission. If I had had this insurance when I first diagnosed I would be deep in debt and probably sick. I haven't been really sick since I was insured through the state but the copays and the denials will eat you alive.