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Ugh! Should never have changed insurance

Kaleena's picture
Kaleena
Posts: 1227
Joined: Nov 2009

I really hate insurance companies. It's like they are the doctors treating us. I changed insurances in April. It was so hard paying out $2,600 a month for a family plan and they were going to raise it. We went on a group plan through work (we are self-employed) with another company and the premium dropped to $1,400 a month.

I was promised that I would be able to get the same treatment, care, scans, etc. that my old insurance company had. They even told me I was able to get 4 PET scans a year. Although my doctor is out of state, I was told that all he would need to do is draft a letter, email, or the like and indicate that he was my main treating physician for my cancer follow-up care.

I had my six months check-up last Monday (everything looked good). My last PET scan was in November, so the doctor said I could have my Port removed and probably do another PET Scan (because in Feb of 2010 they removed a lymph node with microscopic cells during surgery). I had both scheduled for today. However, the insurance company denied the PET Scan saying that it didn't meet the medical reasoning for testing. They want you to have a CT first and if they see something get a PET Scan.

So I had to cancel both procedures because the port removal would probably cost too much to have done out of state. I could get it here locally, but I ask if they couldn't flush my port here, why would they be willing to take it out. I am so frustrated!

It didn't help that I was in the middle of moving our home, our office, and my middle son graduating from high school, along with contractors in my home and then to deal with the fact that the insurance company is running our health treatment. So I had a break down last night. Then sat at the outdoor fireplace and chilled and talked with my husband. Now I am back and ready to fight again!

The saga continues......

Kathy

jazzy1's picture
jazzy1
Posts: 1387
Joined: Mar 2010

Kathy,

I do feel for you and for this major fact of insurance companies promise and don't deliver, I choose to not change my plan or company. The sales rep wanted the sale and fibbed a bit, you think?

We're self-employed and have a huge deductible $10K which must be met each year, then everything is paid out at 100%. Ouchie but the premiums aren't close to what you pay. I did change to the higher deductible 2 months prior to my cancer diagnosis and would like to kick myself. Of course, I was always healthy and our broker suggested to follow my past good history, but who'd have "thunk" this was in my future...cancer!~

Be thankful you have coverage and possibly in the end pay out with scans, etc, that come to your prior high premiums.

Keep fighting as that's how we all win!!!

Jan

Kaleena's picture
Kaleena
Posts: 1227
Joined: Nov 2009

Thanks Jan and Lori:

I am mostly mad at myself for changing. Yes I hated paying those premiums, but I was all set up with my doctor in Ohio. Now, like Lori says, I have to get everything pre-approved. Before, the doctor's office would set up the dates and then get the approval. I didn't really have anything to do with it. Now, I have to do the work.

Well hopefully I will get it worked out soon.

Thanks again for your input.

Kathy

Northwoodsgirl
Posts: 201
Joined: Oct 2009

Insurance companies are supposedly highly regulated but yet we each enroll into a group health policy through work where we only get very limited information. We don't even get the more detailed certificate of coverage book or standard plan document until we ask for it! And the burden is of course on us to alway check and double check if a procedure is covered prior to having it. Just what we want to be burdened with when we are feeling so poorly to start with. Getting a disease like cancer is financially devestating....and most of us aren't Medicare age yet. Ugghhhh....
Lori

california_artist's picture
california_artist
Posts: 860
Joined: Jan 2009

I buzz off a letter to the president, just to let him know how the little folk are faring out here.

when you do that apparently everybody at the White House gets your email address and the are just the most chatty bunch over there.

Can't blame a girl for trying.

and where in the world are you anywho?????

Near the upper peninsula in Michigan????per chance

Kaleena's picture
Kaleena
Posts: 1227
Joined: Nov 2009

Claudia:

I was just thinking about doing that, but wasn't sure of the address, other than "White House".

The health premiums stink. And then there are the taxes!
municipal tax, local tax, federal tax, worker's comp tax, self-employment tax (they take approx 50%), school tax, real estate tax, state tax, and now the our state is trying to impliment a tax for everything you buy for your business. Inheritance tax. Also, because we are self-employed, my kids are not able to get Federal funding for college so it comes out of our pocket. This year I will have 2 going!

Don't get me started on credit card rates! lol

Ugh Ugh Ugh!

Thanks for letting me vent! I feel much better! :}

By the way, I live in Western Pennsylvania, outside of Pittsburgh.

Kathy

california_artist's picture
california_artist
Posts: 860
Joined: Jan 2009

This was at the bottom of something I got from Bidden's wife Jill, along with millions of other folks I guess. One was about who I would nominate as a special person helping others.

This email was sent to claudiaallen27@yahoo.com.
Unsubscribe claudiaallen27@yahoo.com | Privacy Policy
Please do not reply to this email. Contact the White House

The White House • 1600 Pennsylvania Ave NW • Washington, DC 20500 • 202-456-1111

The contact the White House thing was in blue on the email I don't know if you cut and pasted like I did if would turn blue again or not. But I imagine I got the original address from google.

I originally wrote to offer my suggestions regarding the war. you may have some feeling for how opinionated I tend to be, but if I was looking for someone to really listen to me, I would write a personal letter, handwritten to the 1600 address.

Just a thought.

Pittsburg isn't that far from here.

Thinking of you--and hoping for the best

california_artist's picture
california_artist
Posts: 860
Joined: Jan 2009

Not about cancer, just about where you live. My father's family is from a small town in PA, called Bairdford. It's a lovely area.

He lived in a log cabin with 9 other brothers and sisters, had an outside well, and outhouse. It was just the most beautiful place. He and his brothers and sisters planted an assembly style pine forest of over 100 trees. I saw the trees when then had become an almost etheral forest. I miss my dad. And the log cabin has been taken away, log by log, all that's left is the rootcellar.

One of my regrets in life is that I didn't think about the log cabin for years and then when I did, it was this empty hole. There is nothing I can do to fix that.

Guess there are just some things you can't fix. Regrets, while regrettable, just give one a boost to do better in the future. They are things, now done to learn from.

Hopefully, someday you and I will meet. I think I would like that. I still have cousins in Pittsburg.

Once my ancestors got off that pesky Mayflower, they tended stay in the PA and Ohio areas for decades.

Thinking of you,

Claudia

Kaleena's picture
Kaleena
Posts: 1227
Joined: Nov 2009

Its been a very busy week for me here so I haven't been on much. I would truly like to take a road trip soon! Bairdford is in the northern part of Allegheny County and I live in the southern part of Allegheny County - Pittsburgh is in the middle. It is not too far away.

I grew up in a town called Finleyville which is in Washington County. We had well water for a long time and a neighbor across the street had an outhouse! All the homes had at least 2 acres of land or more. My dad would always have a garden. He is gone now too, but my mom still lives there. I, on the otherhand, now live in Jefferson Hills. We have 3 acres. However, they are building so many housing plans with many "lots". I would love to buy up all the land so that can't happen, but I guess I would have to win the lottery or something!

I always wanted a log cabin/home. Your father's place sounded so peaceful. I would love to see the forest that they planted. Don't feel bad about the cabin though. As we grow, we learn to appreciate things more. I know my sons don't think one way or another but there will come a time in their lives that they will realize what my husband and I are trying to give them.

Talking about Ohio, I go to Cleveland Clinic. It's about a 3 1/2 hour trip to get my checkups. How close are you to Cleveland?

Thanks for thinking of me. I really needed it today.

Kathy

daisy366's picture
daisy366
Posts: 1493
Joined: Mar 2009

Kathy,

I too have had my problems with changing insurance. The bottom line is - we need to know the coverage from the written plan. Also things like PET scans have "protocols" which you found out about. IF we meet these protocols THEN we can get those 4 scans a year. The person failed to mention that to you because they wanted to get the commission on the sale probably.

I recently had problems with my new insurance (BC/BS). I compared the summary page with my previous (Aetna) and they looked comparable .....NOT. New policy had copay of $300 for my port flush (used to pay $40). The insurance company "advocate" setup a home health service to do it for $35. I scatched my head on the logic of this but trusted that it would work...NOT. I got stuck for $110 this time. My appeal fell on deaf ears. The company lied and said that they told me about this...yad yada yada... After much time on phone with everyone and their brother, I am getting port flushed at a rival oncology practice (the first time I requested care from them they turned me down. The second time I connected with the soft heart of office manager who got soft-hearted doc to see me just for flush. I kiss their feet every time I go there - today is second flush).

Bottom line as we chalk this up to "live and learn", This certainly does not help our stress level, but WE NEED TO BE EXPERTS BEFOREHAND - EVEN READING THE PROTOCOLS ON EXPENSIVE PROCEDURES LIKE PET SCANS. FIGHT, FIGHT AND KEEP FIGHTING. GET YOUR DOC TO HELP YOU.

I hope you get the treatment you need, Kathy. My best to you. Mary Ann

Kaleena's picture
Kaleena
Posts: 1227
Joined: Nov 2009

How have you been, Mary Ann. I hope you know I think about you and hope you are doing well.

I have been pretty busy. Besides moving our home, we are in the process of moving our office and now fighting with insurance. Yuck! I used to have BC/BS but the premiums were so outrageous. But I found out that BC/BS has some reciprocal agreement with the State of Ohio so things are covered. I live in Pennsylvania. Even before we switched, we took over three months outlining the details so that this wouldn't happen, but it did. We are now in the process where they want my doctor to call the acceptance department and ask them to accept him into the plan. HOwever, I still don't think I can get my tests done at Cleveland. Also, even though my doctor asked for a PET Scan, I don't fit the "medically necessary" criteria to have one done so they will only approve CT scans and then if they see something would they order a PET Scan. I say just go to the top first and only have one or two scans a year. It would save so much time, money and agony.

Before we went with this company, we took over three months to decide this. When a problem arose with them accepting Cleveland Clinic, I was so upset and said forget it I didn't want anything to jeopardize that. I was assured that it was all taken care of and that they would approve 4 PET scans a year. The only thing they didn't tell me was that it had to fit the medical necessary criteria and just because your doctor orders it, doesn't mean you get it. Or that I would have to have the tests done locally where the local hospitals wouldn't flush my port. The said thing is that it has been five months now without a flush and now my port is probably not good.

Get this. We asked the insurance company to send us an appeal form or give us the address of the appeal office. He tells us they don't have one. Yea, right! So what to do. We will wait until my doc gets approval (or not) or we will switch again which will cause us to pay $2,600 a month in premiums or pay $7,000 deductible plus 40% of the entire bill each time. (it was supposed to be $3,000 deductible only)

You are right, Mary Ann. It doesnt help our stress level. It was more stress than I wanted this time of year. Moving alone is stressful. A son graduating is stressful. Two sons now in college is stressful. Moving the office is stressful. HELP! lol

That's why I am having a nice small glass of wine right now!

Thanks for your input, Mary Ann. I hope this post finds you well and you are enjoying your summer.

Kathy

Kaleena's picture
Kaleena
Posts: 1227
Joined: Nov 2009

How have you been, Mary Ann. I hope you know I think about you and hope you are doing well.

I have been pretty busy. Besides moving our home, we are in the process of moving our office and now fighting with insurance. Yuck! I used to have BC/BS but the premiums were so outrageous. But I found out that BC/BS has some reciprocal agreement with the State of Ohio so things are covered. I live in Pennsylvania. Even before we switched, we took over three months outlining the details so that this wouldn't happen, but it did. We are now in the process where they want my doctor to call the acceptance department and ask them to accept him into the plan. HOwever, I still don't think I can get my tests done at Cleveland. Also, even though my doctor asked for a PET Scan, I don't fit the "medically necessary" criteria to have one done so they will only approve CT scans and then if they see something would they order a PET Scan. I say just go to the top first and only have one or two scans a year. It would save so much time, money and agony.

Before we went with this company, we took over three months to decide this. When a problem arose with them accepting Cleveland Clinic, I was so upset and said forget it I didn't want anything to jeopardize that. I was assured that it was all taken care of and that they would approve 4 PET scans a year. The only thing they didn't tell me was that it had to fit the medical necessary criteria and just because your doctor orders it, doesn't mean you get it. Or that I would have to have the tests done locally where the local hospitals wouldn't flush my port. The said thing is that it has been five months now without a flush and now my port is probably not good.

Get this. We asked the insurance company to send us an appeal form or give us the address of the appeal office. He tells us they don't have one. Yea, right! So what to do. We will wait until my doc gets approval (or not) or we will switch again which will cause us to pay $2,600 a month in premiums or pay $7,000 deductible plus 40% of the entire bill each time. (it was supposed to be $3,000 deductible only)

You are right, Mary Ann. It doesnt help our stress level. It was more stress than I wanted this time of year. Moving alone is stressful. A son graduating is stressful. Two sons now in college is stressful. Moving the office is stressful. HELP! lol

That's why I am having a nice small glass of wine right now!

Thanks for your input, Mary Ann. I hope this post finds you well and you are enjoying your summer.

Kathy

california_artist's picture
california_artist
Posts: 860
Joined: Jan 2009

Something you said reminded me of the movie Sicko by Michael Moore. Tell them you are going to write to him about this whole thing. See if that doesn't get you a scan. the insurance companies are scared to death of him and his video camera.

did you write to the president of the first lady?

Thinking of you,

claudia

Kaleena's picture
Kaleena
Posts: 1227
Joined: Nov 2009

Claudia:

I do remember Michael Moore's movie. And I haven't had time to write to anyone yet. We are moving our office and I am involved in a 3 day festival and my middle son leaves for college on Saturday.

But that is such a great idea! Thanks.

Hope you are having a great day. Love the cat.

Kathy

california_artist's picture
california_artist
Posts: 860
Joined: Jan 2009

Here's his email address

Email: Write an email mike@michaelmoore.com

Kaleena's picture
Kaleena
Posts: 1227
Joined: Nov 2009

Claudia:

You are definitely the go to girl! You have all the good contact addresses!

california_artist's picture
california_artist
Posts: 860
Joined: Jan 2009

Well, you would need to go to Chicago, go east a couple of miles and head north about, I don't know, Chicago is around six hours from here, pretty much straight south.

I'll get a map. I can get anywhere with a map and a few bucks, or a truckful o' cash.

Do you have ticks where you live? Lyme Disease type ticks? The Upper P. of MI is study center for Lyme Disease ticks, cause we are infested with deer. I can't go to parks here. Cancer sucks, but lyme Disease would suck additionally,

Love ya,

Claudia

Kaleena's picture
Kaleena
Posts: 1227
Joined: Nov 2009

Claudia:

We have a lot of deer here. There is a family of deer in our backyard. In fact, I just saw them tonight. Plus turkeys, rabbits, rac****s and even possums. Also, it is strange, but we have areas with coyotes. There are foxes around, but I only saw one as road kill. Ticks are mostly in the heavely wooded areas around here but more prominent north of where I live.

My boys went to Chicago last year for a band trip. The band might be going in March again too. My boys had a great time in Chicago.

Hey, but sounds like a nice road trip to me! Why wait for a band trip! lol. Especially since we do not have any plans yet for a vacation. But like you said, I need that truck full of cash!

Kathy

daisy366's picture
daisy366
Posts: 1493
Joined: Mar 2009

You are very kind. I'm doing well, thnaks - at least today. I see my doc on Wed - got my fingers crossed. I'll let you know how that goes.

It's a tough call with insurance. here's my unsolicited advice re: PETscans. I had the same problem awhile back. After much hoopla and appeals, I ended up getting the CT scan first and then they finally approved PET. These days, I try to "chalk things up" to "this is the way it's supposed to be" and not stress so much. The fighting thing is only good up to a point. We need to weigh the pros and cons of time,energy, stress, etc. I tend to "go with the flow" more these days. It seems to be keeping me more mellow and hopefully, healthier.

Once, I had official recurence, Aetna approved PETs without hassle. The jury is out on what BC/BS will do until doc orders one. ((Deep breath))

You've had so much going on in your life. Do whatever your gut tells you is best for your stress level and pocketbook.

With Much love and caring, Mary Ann

Kaleena's picture
Kaleena
Posts: 1227
Joined: Nov 2009

Mary Ann,

You are so right. It has been so stressful for me the last couple of months and as a result I let the negative vibes in. I think now that I am almost rid of all my stress, I should be getting back to normal.

I am not going to worry about the tests (too much anyway). It is what it is. If I have to get CT first, so be it. However, I didn't start getting PET scan until after my recurrence in 2009. After surgery in February of 2010, the results were negative however they had removed a lymph node which had some microscopic cells. I had two PET Scan since then and I would think that should be good enough for future PET scans.

The real reason I was stressing is because I have an ache in my back and because I was stressed I started thinking the worse (dah!) which caused me to stress more. Like I said, when you are stressed you let the negative thoughts come in. I didn't mention it to my doctor either cause I thought I would be getting the scan. But someone told me that if you don;t have stomach muscles (since the many surgeries I have had), that sometimes your back muscles work harder to compensate. It makes sense.

Thanks for your reply and kind words. I have be thinking of you on Wednesday. fingers crossed here to for you!

Sending hugs,

Kathy

daisy366's picture
daisy366
Posts: 1493
Joined: Mar 2009

Kathy,

I am not a doctor BUT I do think you still have stomach muscles!!! We get them cut but they are sewn together again.

hugs, Mary Ann

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