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Pay up front?

ausrebel53's picture
ausrebel53
Posts: 73
Joined: Dec 2012

I was due for radiation and chemo tomorrow 1/15/2013. The chemo people called to say they will require $1700 prepay up front for first week and $290 per week after that for Erbitux (about 7 visits). Up to that point I have had 6 operations and 11 teeth extracted along with many visits to various doctors at $40 per visit prepay. If we were given some warning regarding cost and having to pay up front things would have been ok, or at least give us some sort of payment plan. At least the radiation people said they would give us some sort of payment plan, lets hope it is reasonable. I will be seeing a social worker soon to discuss finances and disability of some sort which will help no doubt.

I just thought it was a little rich being told at the last minute to come up with $1700 etc. as if everyone has a spare few thousand lying around.

Any thoughts?

Michael

phrannie51's picture
phrannie51
Posts: 3601
Joined: Mar 2012

...for some reason I thought that is where you live.  This is the first time I've heard anybody having to come up with "front money" when they have insurance.  I know that somebody here will have some ideas....I didn't have to face anything like that.....just paid my co-pay and the rest they billed out.....kind of a "built in" payment plan....the kind where I send as much as I can....and they just kept billing till it was paid off.

p

Billie67's picture
Billie67
Posts: 834
Joined: Jul 2012

I didn't have to do more than just pay a copay each time. I think it's a little harsh to ask for that up front. I think in our state they can't ask for more than your copay. Do you have HMO or PPO?
My question to them would be, "what if I don't have it?"
There are other facilities to go to I'm sure??
Good idea on the social worker. Keep us posted.
Billie

Ladylacy
Posts: 457
Joined: Apr 2012

My husband never had to pay anything up front.  We were billed after insurance paid.  This was for both radiation treatments (2 different times) and all of his chemo treatments.  The only upfront we had to pay (co-pays) were for the doctor visits.

Ingrid K's picture
Ingrid K
Posts: 810
Joined: Mar 2011

Michael

You look too young to be on Medicare, so I'm sure you mean private insurance.  WOW, it sucks to find this issue out just the day before.  They couldn't get the OK before now ?  I was not on Medicare either, but the hospital checked right away about insurance coverage for me and luckily I had just retired from a major telecom company so I had terrific insurance and all was covered.

Definitely get to see the social worker.....they usually know all the little tricks/tips needed to help in your situation.  Perhaps the treatments weren't coded correctly and therefore denied by insurance ?  sometimes it could be a miscommunication issue and easy to resolved.

Hope you get this taken care of and you can start on the road to complete recovery.

VivianLee5689's picture
VivianLee5689
Posts: 546
Joined: Aug 2012

We have to pay 15% of expenses for health care up to 2700 to meet our deductible, then insurance really kicks in.  This means right after Christmas if you have procedures you have to find money somewhere.  David has a bone marrow biopsy on the 22 so I am sure we have a big deductible to pay then.  I don't know if this is your situation or not.

ausrebel53's picture
ausrebel53
Posts: 73
Joined: Dec 2012

Hope Davids biopsy goes ok Vivian. Hope you feel better lately, we were worried about you as you seemed upset recently.

Please take care

regards Michael

phrannie51's picture
phrannie51
Posts: 3601
Joined: Mar 2012

deductable you've already paid when you're seeing 3 or 4 doctors, and they all have separate charges, and separate lab tests etc....I wonder if the Rad place called your insurance company and asked how much they would NOT pay and they said $1700.....which considering that rads are pretty expensive, isn't that bad a deal....I think mine ran close to $85,000 by the end of the 7 weeks.  It's just  too much to come up with at one time. 

p

ausrebel53's picture
ausrebel53
Posts: 73
Joined: Dec 2012

It wasn't the rad place Phrannie, it was the chemo place (the rad place will have no pre pay or deductable)

katenorwood
Posts: 1804
Joined: May 2012

Michael,

I had to make a rushed descission back in '11....due to my insurance deductable coming back around in less than a month.  Would have had to come up with the first $6000 up front.  So yeah this is probably an insurance blurp.  I would hope that this social worker will have fantastic resources for you when you meet with them.  Like you needed this on top of just getting better.  Let us know if things work out....otherwise we'll dig for more resources o.k. ?    Katie

wolfen's picture
wolfen
Posts: 1170
Joined: Apr 2009

I try to stay pretty much on top of what bills to be expecting, so I'm frequently checking Medicare and our secondary to see what portion has been paid by each. For the most part, we're not asked to pay the co-pay upfront. But the hospital bill for hubby's recent stay has me stumped. The amount billed to Medicare was approx. $75,000 and all of it was Medicare approved. But the amount paid by Medicare was only $11,500. So, I'm lost on this one. Waiting now to see what UHC is going to pay. Surely this can't be right. All the many doctors involved seemed to get paid the correct amount.  Will probably end up owing about $1,000 to them. All this before his cancer treatment has even started. Haven't even see the first bill from MDA yet.

If the hospital is seriously expecting the balance of $75,000, you guys can come visit me in debtor's prison.

Luv,

Wolfen 

ausrebel53's picture
ausrebel53
Posts: 73
Joined: Dec 2012

I hear what you are saying Wolfen, fortunately there is no more debtors prisons. My only fear is losing our house which we own outright.

regards Michael

ausrebel53's picture
ausrebel53
Posts: 73
Joined: Dec 2012

Thank you Katie, would really appreciate any help, it may just be the deductable coming back around to bight us.

ausrebel53's picture
ausrebel53
Posts: 73
Joined: Dec 2012

Thank you for your concerns. I live in Florida Phrannie (Panama City Beach) and have private insurance through my wifes work, she is an RN at the local hospital where I have been going. I would have thought her insurance would be pretty good, (has been up to now) we pay over $500 per month for family insurance. I'm still a little unsure how the deductable works as we haven't had to see a doctor very much at all. Australia has public health insurance which sucks, it pays for everything but you can literally die waiting and the quality can be questionable for anything serious.

I originally came from Australia Phrannie but married my beautiful Southern Belle, Kelly....I am a permanent resident (legal)and have lived in the USA for nearly 14 years and have worked most of that time. I just turned 60 in case you were wondering.....my wife keeps me young heh heh, I do love it here especially the South.

I will definatelly keep you posted Billie, again thank you for your responses, it didn't sound right to me.

George_Baltimore's picture
George_Baltimore
Posts: 303
Joined: Jun 2009

relax!!!  Medicare reduces the amount billed by doctors, hospitals,etc.  You shouldn't have to pay what Medicare and your Medi-gap insurer don't pay.  Medicare enters into agreements with health providers.  In most cases, they agree to accept whatever Medicare pays.  Since it's January, any services you incur this month will probably have a yearly deductible of $155 (off the top of my head) attached to it that you would have to pay.  This is a one time deductible.

OOOPPPS, I just reread your post.  For inpatients in a hospital the deductible is somewhere around $1100 but that is nowhere near $75000.  Sometimes a hospital will waive the deductible if it would cause a financial hardship.  They would give you forms to fill out and you would have to send them back to the hospital along with copies of your last two bank statements, proof of income, etc.

As far as insurance coverage for treatments, when I received treatment back in 2004, I was not on Medicare or Disability.  I had BCBS.  They footed my bills to the tune of over $156,000.  Neither my chemo or radiation facilities ever asked for any pre-payment.  They billed BCBS and whatever small amount wasn't covered, I paid.  BCBS is not cheap, but if you have a big illness, they are definitely worth it.

If you live in the states, I would definitely apply for SS Disability.  For certain type cancers, they will approve you without you having to fight with them.  Once you are approved for disability, you can then apply for Medicare and your bills will be pretty much be paid.

ausrebel53's picture
ausrebel53
Posts: 73
Joined: Dec 2012

This is certainly wierd, had my first radiation treatment today and was told insurance covered 100%, didn't have to pay a dime (whew). The rad doc said he was concerned but gave me an alternative chemo doc if we can't sort out insurance issues with the (yes I'm going to use the word) idiots at the first chemo doc. Love being in a position of strength when bargaining, I feel it's one point for our side especially since we are so vulnerable in many ways. The first chemo doc will lose a crap load of money if I choose number 2 which I am more than willing to do at the drop of a hat (greedy bast***s).

Regarding hospital care Wolfen, I used the same hospital where my wife works as an RN and only had to pay a surgeons co pay, we didn't have to pay any hospital fees of any kind. We do have good insurance but they seem to try to bluff us at times, they initially tried the pre existing number on us which seems to have been resolved.

Will keep you blokes and shielas (guys and gals) informed on the outcome of the chemo fight.

Thank you for your input

Regards Michael

phrannie51's picture
phrannie51
Posts: 3601
Joined: Mar 2012

and you didn't have to cough up $1700....phew!  Anyway, you are on the road, and that's a good feeling after having to wait and wait...getting everybodies poop in a group, while you're thinking the C is wrecking havoc in your body.  Glad everything worked out.

p

Ingrid K's picture
Ingrid K
Posts: 810
Joined: Mar 2011

Glad you are able to get the treatment started, Michael.

As P51 says, that's a huge first step towards your ultimate recovery.

BEST OF LUCK TO YOU.

ausrebel53's picture
ausrebel53
Posts: 73
Joined: Dec 2012

Yes Phrannie, it is good to finally get started....like trying to lay a square egg. Thank you

donfoo's picture
donfoo
Posts: 1144
Joined: Dec 2012

Glad it worked out Michael. Dealing with the direct medical issues is enough, adding a financial track of issues just adds more to the plate.

Don

NJShore's picture
NJShore
Posts: 411
Joined: Nov 2012

Michael, 

so happy to here it's getting easier for you!  I hope the chemo folks can be helped by the social worker!

oh, and now I am going to have to re-read all your posts, so I can imagine the appropriate accent as I read. 

You might be interested, here in Philadelphia, I met another couple, been here for months! Months of hotel bills, and he is getting three treatments, which require 3 weeks hospitalization. They had to put $150k down for his first treatment. They are from Australia, getting a cure they couldn't at home. They will return broke, but I pray with a cure.

Kari

 

ausrebel53's picture
ausrebel53
Posts: 73
Joined: Dec 2012

Thank you for your good wishes, the original reason for the insurance glich was the chemo doc wanted to use Erbitux as he felt this the best way to go. The insurance company came back and said this would have to be pre approved which would take 30 to 90 days (they kidding?). The chemo doc explained to them this proceedure had to be in conjunction with radiation therapy for it to be fully effective and that I had already started radiation. Unfortunately Kelly's work (hospital) recently changed hands and consequently changed insurance, the old insurance always approved these proceedures without any preapproval requirements.....not the new ones.

The chemo doc came up with a new plan, they would use cheaper meds and be able to charge less: $600 up front, the second visit $250 then $150 per visit after that. Due to the fact that I have already started radiation thus leaving us no time to explore alternatives (insurance has timed it perfectly) my wife, Kelly has really insisted on taking the recent offer. If the pre approval goes through, this "prepay" would be returned to us. "IF" I'm taking the offer because I am too frigging tired to fight and I don't wish to stress out my wife too much.

I hope you are all confused coz this is sure confusing the crap out of me. As I have previously said, where I come from, Australia has public insurance (like Obama care) and bean counters and beaurocrats DICTATE (and I emphasize that word) what medications or treatments are used, NOT DOCTORS. My dear mother spent her last years in New Zealand that also has public medical insurance. She contracted lung cancer and 2(Ibelieve) years after that metastisised (however you spell it) to the liver. I was able to spend the last couple of days with her in hospital in Aukland thankfully. What really shocked me was the day before mum died the nurse came in and wished I meet with her doc, what those (insert adjectives here) did was suggest I move mum to a private hospital, sadly mum passed away the next day. I told them they would move my mother over my cold dead body, let her go in peace I said. The point I make here is you will not be saved if over a certain age or at a certain level of sickness with public insurance....too expensive. I have grown to love this country the more I see of it, we Australians are fiercely independant and individualistic beneath that carefree exterior, and we strongly identify with the USA....we've been mates for ages. I guess it just saddens me to see some freedoms seemingly erroded and I pray you keep this country in the hands of the people coz i've seen what happens when a country leaves the hands of the people. I'm happy to work and pay my way, sometimes one just needs a little help not a last minute landslide

Guess I better step down from my soap box, this episode has brought back some bad memories and made me a little paranoid. I thank you for your time

ausrebel53's picture
ausrebel53
Posts: 73
Joined: Dec 2012

I will still see the social worker, just haven't had time yet.

Billie67's picture
Billie67
Posts: 834
Joined: Jul 2012

That you got most of the mess figured out but what a pain in the butt! Many of us have had Erbitux and many of us have different insurance companies and coverage but yours seems to be a real gem! There was no question or problem with mine accepting erbitux as treatment. I really wish you luck getting this all settled in your favor.
Billie

ausrebel53's picture
ausrebel53
Posts: 73
Joined: Dec 2012

Thank you Billie, gem is the word

George_Baltimore's picture
George_Baltimore
Posts: 303
Joined: Jun 2009

Glad to hear things are working out for you.  Your chemo people really did seem insensitive.  Also, thank you for your wishes for our country although I'm not sure it will do any good by the time this bunch of idiots (not the word I REALLY want to use) in Washington get through with us in the next four years. Our school systems are worthless anymore.  Some of the kids probably know more than the teachers.  They don't even teach cursive writing anymore.  My sister told me that when my one nephew had a little trouble reading a birthday card I had given him.  I thought she was kidding until my next door neighbor, who was a teacher, verified it.  We are turning out mindless people who can't see what is happening to our country.  Thank God I am nearing the end of my life.  I feel sorry for the next generation.  I hope they won't have any problems learning to speak Chinese.  I better shut my trap before I have the Secret Service or the Mind Police knocking on my door.

ausrebel53's picture
ausrebel53
Posts: 73
Joined: Dec 2012

I'm pretty sure we are both "on file" somewhere George hee hee, what the heck. I can't really comment on your education system, we have lived in a small country town in Nth Alabama for about 10 years during which our children (my step children) were educated at a local school. While the town was fairly poor the school was first rate. I have seen this in a number of places, I guess the local govt. tries to make up in education what it lacks elsewhere. My wife and I have tried to be hands on with their education which I think pays off in the long run. I can see where the larger cities can have problems, it comes down to money to a point but some of the blame rests on the shoulders of parents. It's hard to say George, there are good and bad points in both countries. I try to stay positive and do my bit as best I can.

Yes it is sad the world seems to be heading in a left direction, we seem to become more of a "microwave instead of a grow and cook ourselves" society, relying more and more on immediate gratification instead of waiting and saving. Patience is something to be valued, our experience with cancer and the time it takes to prepare, heal and deal with insurance/finance etc. most certainly strains our old patience muscles that have grown flabby with misuse.

It is inspiring to see young caregivers and patients on this site acting so selflessly and with such maturity, with people like these George I have great hope for the next generation. I believe things will turn around if push really comes to shove, I would like to hang around for a while just to stay in the fight.

Regards

Michael

 

 

 

 

 

George_Baltimore's picture
George_Baltimore
Posts: 303
Joined: Jun 2009

You're a wise man.  This country has gotten so permissive and litigious it's crazy.  When somebody can sue a restaurant because they spilled hot coffee on themselves and be awarded millions of dollars or a president that appoints a tax evader to become the head of the Internal Revenue Service it just makes you sit down and think, "My Lord, can it get any worse?"  I get the feeling that the person that started the joke that goes, "What do you call 10,000 lawyers at the bottom of the sea?" (a good start) wasn't far from the truth.  There are WAY too many lawyers in this country!!! (Have I offended anybody yet?)  I'm not saying that there isn't a need for lawyers, there are just too many of them for them all to make a living and that leads to absolutely insane lawsuits.  

Sorry for all the venting folks, I just really needed to do that to keep my sanity.  And I really haven't meant to offend anyone!  Michael, I wish you the best in your treatment.  Take care.

ausrebel53's picture
ausrebel53
Posts: 73
Joined: Dec 2012

Hey George, I enjoy a good vent especially when it includes a lawyer joke....good one. This is what we are here for anyway, this cancer business is frustrating and at least here we can air our feelings and be understood and be laughed with instead of being laughed at.

I never realized how little time I had to think before cancer, things seem to take on a new perspective when spending so much time waiting and preparing for treatment. I have been so busy in the past with work, family etc. etc. it truely seems a luxury to be able to just reflect. Many years ago I trained at a classical art school (drawing and painting) and was deeply involved in the art scene, sadly I drifted away due to financial responsibilities. I may now be given a second chance. Grandma Moses (Anna Mary Robertson) didn't take up painting until she was 76, I remember reading of many other artists who started late in life, I just can't recall any names at the moment, pain meds have my brain messed up. Maybe someone here can recall some late starting artists.

I guess I digress.

On a positive note the newly aquired free time we have been given may even open up new opportunities we hadn't considered before when we were so busy.

Thank you for your best wishes, I hope all goes well for you too George as well as everyone else here

Regards

Michael

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