Recurrence

Rosesforever, so sorry to

Rosesforever, so sorry to hear this! There are so many available treatments these days. I'm surprised that your gyno doc told you that. I hope your chemo doctor is right and they find the correct balance of something to get you stable. Many, many women here have gone through multiple recurrences and are still here with us. Please don't give up. I'm glad you are going to get a second opinion. Please come back and let us know what they tell you. We are here for you!

Love and Hugs,

Cindi

Article

Rosesforever,

I know that you've struggled with severe side effects from your cancer treatment, so I'm very sorry to hear about this recurrence. I agree that a second opinion would be very helpful in your situation. I hope that you're able to have this done soon.

And I wanted to remind you of an article that was posted on the board last year that may be especially timely for you now: "Metastatic Cancer Is a Chronic Condition"

https://www.onclive.com/view/metastatic-cancer-is-a-chronic-condition

Please keep us posted on your next steps.

Hi Rosesforever. Firstly, let

Hi Rosesforever. Firstly, let me say I am sorry that you have a recurrence. I have recurred myself so many times and I keep bouncing back, although it does take longer each time. My original prognosis was pretty good but that went out the window fairly quickly. That said, I'm living proof that metastati cancer is a chronic condition! I live in Texas. I had a second opinion at MD Anderson in 2018 at the urging of my gyn/onc. I am not familiar with your insurance situation and I am wondering if during open enrollment there might be a plan that MD Anderson would take. I had thought they pretty much accepted all insurance. I am sad that with everything you have going on you have to fight to find a second opinion. It really should not be this way.

Jan

Medicare

Roses, I am not on Medicare, but I know a little about it from my previous work, and it sounds like the problem you're encountering is that your Medicare through Kaiser is Medicare Advantage, which is managed care. By definition, that means that the company through which you have Medicare Advantage (Medicare managed care) can limit your options for where you can seek care. The problem likely is not with MD Anderson but with Kaiser (your managed care company), which apparently will not pay for you to go outside their network because they don't contract with MD Anderson. 

"Traditional" Medicare is not managed care, and people in traditional Medicare are allowed to get care from any provider or institution that accepts Medicare, which MD Anderson does.  Medicare open enrollment period starts in mid-October and ends in early December, and you can switch to traditional Medicare during that period, although your new plan wouldn't start until January 1, which may be longer than you want to wait. If you do switch to traditional Medicare, you will need to get a supplemental (MediGap) plan and will need to take care that you choose a MediGap plan that contracts with MD Anderson. If you get your insurance through a retirement plan that requires that you use Medicare Advantage (which I think some do), then you may not have the ability to switch. Also, in many, perhaps most, states you might not have the right to buy a Medigap plan without going through medical underwriting if you switch to traditional Medicare during open enrollment, and without a Medigap plan, cancer care would be out of reach for most of us.

You may well know all this, so excuse me if you do. I’m not an expert by any means. You likely also have seen this Medicare information on the MD Anderson website: 

"Medicare Part A, or Hospital Insurance, covers hospital stays, hospice care, skilled nursing facilities, and some home health care.

Medicare Part B, or Medical Insurance, covers doctor visits, preventive care and screening, and medical supplies.

Medicare Parts A and B  are both accepted at MD Anderson.  

Medicare Part C, also known as the Medicare Advantage Plan, replaces traditional Medicare. Kelsey-Care Medicare Advantage is the only Medicare Advantage plan with which MD Anderson is contracted.  However, we have a working relationship with some Medicare Advantage HMO and PPO plans.  Please contact your plan to determine if they will work with MD Anderson.

Medicare Supplemental (MediGap) policies allow enrollees to see any provider that accepts Medicare. Some of these supplemental plans are accepted at MD Anderson.  However, we do not accept any supplemental plans that require enrollees to use a provider in a restricted network that does not include MD Anderson or its physicians."

I hope Kaiser relents. I have heard good things about Kaiser cancer care from women on this board, but I know that varies from place to place. I am so sorry that you have to deal with how to get stuff paid for when all your energy should be able to go to getting stronger and managing this disease. It makes me furious.

 

Forherself said:

Roses

I also am sorry to hear that you are having another recurrence.   Darn disease.  We are not allowed to use stronger language.  

I am no expert on Medicare but my cousin taught me this.  Medicare Advantage plans are all preferred provider orangizations.   If you have Medicare you can go to an insurance broker and ask to switch to a medicare supplemental plan.  Any doctor that accepts Medicare will accept you with this.  And that means about 100% of specialists.  I don't know why you have Kaiser and it may prevent you from switching if it is through aretirement plan of some kind.  We had to switch to AARP supplemental and then two months later were free to choose a different company.  I chose Blue Shield.   This may not help but is additional information that I never knew until I was turned down by a Gynecologist in my town when I  was first being assessed for post menopausal bleeding.  I was told it was because of my Medicare Advantage plan.  And I switched.

 

Medicare Advantage that is not an HMO or PPO

I just wanted to say I have a Medicare Advantage plan that lets me go out of the preferred provider list with no penalty.  I love it for that.  So I can go anywhere Medicare is accepted.  I just wanted to let you know there are plans like that.

Rosesforever said:

Thank you. This is very

Thank you. This is very helpful. My concern is if I opt out of Medicare advanrage what will be the long term cost. Kaiser has agreed to present my case to a Gyno oncology board next week. i have been overall pleased with the treatment Kaiser has provided but I have no bases for comparison as I've never had a second opinion. I will check into open enrollment mid October. Thank you again. All the best to you. 

Roses, I think you are wise

Roses, I think you are wise to be careful about switching from Medicare Advantage at this point since, depending on your state, you might have to go through medical underwriting to get a Medigap plan (without which traditional Medicare would require you to pay for a significant percentage of your care). I hope you can make Kaiser work for you. I want to say again, though, that I am not an expert by any means.  Here is a link to wonderful experts -- this is a national nonprofit Medicare rights organization. https://www.medicarerights.org/  They have really excellent free information and will explain everything to you. 

It makes me furious that you should have to worry about this at such a stressful time.