stressed about change in Health Insurance

mariam_11_09
mariam_11_09 Member Posts: 691
edited March 2014 in Breast Cancer #1
okay, I am getting ready to have surgery on Tuesday - masectomy with flap reconstruction. My health insurance at work changed from Blue Cross HMO to Blue Cross PPO and it turns out the Plastic Surgeon is an out of network provide so the health insurance will only cover 70%!! Then I looked up the breast insurance and she does not show up as an in network provide so I am assuming from that I will be paying at least 30% after at $6000 deductible!!! The facility for surgery is in network. I am guessing the whole deal will be around $100 000.

I only got the cards from my new health insurance the day before Christmas and phone this information in on Tuesday this week. So I am pretty shocked. I am having surgery at Stanford where you pay for absolutely everything, you even pay per hour for the IV stand!!

I was pretty calm just preparing for this surgery, organising my daughter to stay with friends, my mother to fly in and help out ....and so on however this has stressed me to a max. I am a single parent with full responsibility of my daughter. Her father is from and lives in West Africa and is not in a position to help out, in fact I send money to him and his family. It is just the way things are however I don't have that financial support and am afraid to go into a huge debt.

I have made a horrible mistake here, not having surgery before Christmas with the HMO. I had no idea it would go this way. Now I am reconsidering surgery and looking into some other way that I could perhaps cure this cancer.

I am going to call Blue Cross on Monday and see what the deal is. I am not sure I am going to be able to sleep between now and then.

unusually stressed for me.

Comments

  • New Flower
    New Flower Member Posts: 4,294
    I completely understand
    and very sorry for your situation. I did happen to me too.
    As my operation was scheduled the provider, UCLA, broke out of the contract with Blue Shield and became out-of-network. I had similar situation and decided to do ahead having surgery. I had radical modified mastectomy with immediate DIEP Flap reconstruction. It took me almost 12 months to sort it out and deal with insurance. As of today they pay most of it,

    You probably still need to have radical mastectomy. You can do reconstruction later or do it now and pay later. Most hospitals offer payment plans and other financial assistance. Unfortunately cancer is a very expensive disease. You did not make any mistakes. Most plastic surgeons do not take HMO. PPO is more expensive, but provide more flexibility and better choice. Call your insurance and ask for explanation. Your treatment is very important and should not be compromised because of changes in your insurance policy.
    Please write me if you have more questions.
    Good Luck
  • mariam_11_09
    mariam_11_09 Member Posts: 691

    I completely understand
    and very sorry for your situation. I did happen to me too.
    As my operation was scheduled the provider, UCLA, broke out of the contract with Blue Shield and became out-of-network. I had similar situation and decided to do ahead having surgery. I had radical modified mastectomy with immediate DIEP Flap reconstruction. It took me almost 12 months to sort it out and deal with insurance. As of today they pay most of it,

    You probably still need to have radical mastectomy. You can do reconstruction later or do it now and pay later. Most hospitals offer payment plans and other financial assistance. Unfortunately cancer is a very expensive disease. You did not make any mistakes. Most plastic surgeons do not take HMO. PPO is more expensive, but provide more flexibility and better choice. Call your insurance and ask for explanation. Your treatment is very important and should not be compromised because of changes in your insurance policy.
    Please write me if you have more questions.
    Good Luck

    Thank-you so much for

    Thank-you so much for sharing your story. Your surgery sounds like what I am meant to have. If you don't mind me asking, what did you mean that it took you months to sort it out and deal with insurance and as of today they pay most of it? Was this because UCLA dropped the contract with Blue Shield?

    WHen I was pregnant with my daughter the company I worked for change health insurance plans in the middle of my pregnancy, I kicked up a fuss because the coverage was not as good and then it turned out they were obligated to give me the same coverage as before. However since I have not started treatment I didn't think I had a leg to stand on here.

    When I look at costs, it will take me years to pay off 70% of that surgery. I am also not even sure about the breast surgeon now. I will call on Monday and hopefully determine some resolution before Tuesday. I am rambling at this point.
  • New Flower
    New Flower Member Posts: 4,294

    Thank-you so much for

    Thank-you so much for sharing your story. Your surgery sounds like what I am meant to have. If you don't mind me asking, what did you mean that it took you months to sort it out and deal with insurance and as of today they pay most of it? Was this because UCLA dropped the contract with Blue Shield?

    WHen I was pregnant with my daughter the company I worked for change health insurance plans in the middle of my pregnancy, I kicked up a fuss because the coverage was not as good and then it turned out they were obligated to give me the same coverage as before. However since I have not started treatment I didn't think I had a leg to stand on here.

    When I look at costs, it will take me years to pay off 70% of that surgery. I am also not even sure about the breast surgeon now. I will call on Monday and hopefully determine some resolution before Tuesday. I am rambling at this point.

    I think you have to pay 30%
    and your insurance will cover 70%. Usually PPO is more preferable for doctors than HMO, I speculating that your doctors should take your PPO.
    As for your question, yes I did my my surgery at UCLA anyway, and then was trying to force Blue Shield pay for it. I felt I did not have time to shop for another medical team. I was correct in my instinct, because my final diagnosis was Stage III C.
    Try to take your new situation easy and talk to your insurance tomorrow.
    Good luck with your surgery and keep us posted,
    New flower Do
  • Lynda53
    Lynda53 Member Posts: 210
    Mariam I have the same issue Jan 01-2010
    I knew my plan had to be chosen for a month.I chose BCBS PPO. I did have my caregiver makelots of calls, and I followed up on more. My new PPO (Anthem) has a transitional care form,(on line) perhaps you too have this.They also have spoken with me at lest 6 times in December to assure an easy/smooth transition.
    However my surgeon is in the plan.as are all the rest.
    Can you check on the PPO website to see Dr's covered?
    I cannot imagine adding the stress of a bill at this time. Perhaps you need some help Monday getting onto the phone to both providers? I had hospitilization DEc 30 and 31st and the hospital wanted my new plan id! I would not give it as I was being treated in 2009. Surely even if tests results come in they are the old plan not the new one.
    s said both my old and new providers, social worker,case managers were very helpful.
    Anything I can do just say so
    Sorry, best of luck
    Peace
  • mariam_11_09
    mariam_11_09 Member Posts: 691
    Lynda53 said:

    Mariam I have the same issue Jan 01-2010
    I knew my plan had to be chosen for a month.I chose BCBS PPO. I did have my caregiver makelots of calls, and I followed up on more. My new PPO (Anthem) has a transitional care form,(on line) perhaps you too have this.They also have spoken with me at lest 6 times in December to assure an easy/smooth transition.
    However my surgeon is in the plan.as are all the rest.
    Can you check on the PPO website to see Dr's covered?
    I cannot imagine adding the stress of a bill at this time. Perhaps you need some help Monday getting onto the phone to both providers? I had hospitilization DEc 30 and 31st and the hospital wanted my new plan id! I would not give it as I was being treated in 2009. Surely even if tests results come in they are the old plan not the new one.
    s said both my old and new providers, social worker,case managers were very helpful.
    Anything I can do just say so
    Sorry, best of luck
    Peace

    I made a few a assumptions

    I made a few a assumptions when I informed the doctors that I would be going from an HMO to a PPO and they both told me I would be covered true. While this is true however I didn't question further to find out how much I would be covered or if they were in network.

    I have looked up on the website to see if the breast surgeon is in the doctor's list and no she is not, nor is the plastic surgeon and nor is the facility. However the health insurance told the facility is.

    Even my primary care physician is not in the list but she had told me she was in the list right before we changed.

    I had very little choices for medical eith was either a PPO or an HRA or Kaiser. The HMO was no longer being offered. This decision I had to make just days after finding out I had cancer but waited a month for surgery because of the christmas holidays and the surgeons had to find time when they could get together.

    The thing is I received a bill indicating that the HMO (old plan) had paid for the visit to the Plastic Surgeon and all the doctors back in Novemeber which also lead me to beleive they were in network for the PPO.

    I will call them, just getting the news on a Saturday evening when I can do nothing until monday morning is where I feel rather stressed.
  • Lynda53
    Lynda53 Member Posts: 210

    I made a few a assumptions

    I made a few a assumptions when I informed the doctors that I would be going from an HMO to a PPO and they both told me I would be covered true. While this is true however I didn't question further to find out how much I would be covered or if they were in network.

    I have looked up on the website to see if the breast surgeon is in the doctor's list and no she is not, nor is the plastic surgeon and nor is the facility. However the health insurance told the facility is.

    Even my primary care physician is not in the list but she had told me she was in the list right before we changed.

    I had very little choices for medical eith was either a PPO or an HRA or Kaiser. The HMO was no longer being offered. This decision I had to make just days after finding out I had cancer but waited a month for surgery because of the christmas holidays and the surgeons had to find time when they could get together.

    The thing is I received a bill indicating that the HMO (old plan) had paid for the visit to the Plastic Surgeon and all the doctors back in Novemeber which also lead me to beleive they were in network for the PPO.

    I will call them, just getting the news on a Saturday evening when I can do nothing until monday morning is where I feel rather stressed.

    mariam, I hope it gets easier and better
    at heaviest thought cancel for now,until you can straighten it out for waht you need
    peace
  • pgrace35
    pgrace35 Member Posts: 122
    Health insurance issue
    As if cancer isn't stressful enough, money issue and insurance coverage just adds to things. As you said, call your insurance company Monday, find out what they are going to cover. Then call the office/hospital of whom ever is doing your surgery and set up a payment plan. I'm up againest a new premium payment now that it's the first of the year, it's $3,000.00, I don't have that,and I start radiation tomorrow, in fact I'm still paying off the hospital from my last premium from my surgery. Also ask the hospital if there are any financial aid programs they may offer. The hospital I went through has a organinzation that helps pay some of your big monthly bills so you can put money towards these expenses if you qualifiy.
    Take care of yourself, do what you have to do,it's too important not too. Pay them what you can afford monthly and just remember it's only money, your health is far more important.
  • lanie940
    lanie940 Member Posts: 490
    Some Dr.s and Hospitals will
    Some Dr.s and Hospitals will accept what the Ins will pay. the hospital Network I am in does that as from what I have been told. Ins companies really stingy in the percentage they actually pay for the services provided to you. I hear so many complaints about the Government run ins like Medicare and Medicade, but Ins companies don't reeimburse a heck of a lot more. They over-pay their CEO's instead!

    I hope things work out for you.
  • lanie940
    lanie940 Member Posts: 490
    pgrace35 said:

    Health insurance issue
    As if cancer isn't stressful enough, money issue and insurance coverage just adds to things. As you said, call your insurance company Monday, find out what they are going to cover. Then call the office/hospital of whom ever is doing your surgery and set up a payment plan. I'm up againest a new premium payment now that it's the first of the year, it's $3,000.00, I don't have that,and I start radiation tomorrow, in fact I'm still paying off the hospital from my last premium from my surgery. Also ask the hospital if there are any financial aid programs they may offer. The hospital I went through has a organinzation that helps pay some of your big monthly bills so you can put money towards these expenses if you qualifiy.
    Take care of yourself, do what you have to do,it's too important not too. Pay them what you can afford monthly and just remember it's only money, your health is far more important.

    The new out of pocket for my
    The new out of pocket for my husband's policy I'm on is also 3,000. It had been 1,000. But, the company he works for took out a secondary policy, so in the end it's only 1270 out of pocket. We send in the claims to the secondary, and they riemburse, we still will have to pay 3,000 at some point. I know our bills for me have been huge on this new plan wich started Oct 1st. From the hernia surgery, 2 full days in hospital then, and total of 13 in December,plus all the medical tests,CT scan's, X-rays,ultrasounds, the Radiation 30 treatments. Sheesh!
  • lanie940
    lanie940 Member Posts: 490
    pgrace35 said:

    Health insurance issue
    As if cancer isn't stressful enough, money issue and insurance coverage just adds to things. As you said, call your insurance company Monday, find out what they are going to cover. Then call the office/hospital of whom ever is doing your surgery and set up a payment plan. I'm up againest a new premium payment now that it's the first of the year, it's $3,000.00, I don't have that,and I start radiation tomorrow, in fact I'm still paying off the hospital from my last premium from my surgery. Also ask the hospital if there are any financial aid programs they may offer. The hospital I went through has a organinzation that helps pay some of your big monthly bills so you can put money towards these expenses if you qualifiy.
    Take care of yourself, do what you have to do,it's too important not too. Pay them what you can afford monthly and just remember it's only money, your health is far more important.

    The new out of pocket for my
    The new out of pocket for my husband's policy I'm on is also 3,000. It had been 1,000. But, the company he works for took out a secondary policy, so in the end it's only 1270 out of pocket. We send in the claims to the secondary, and they riemburse, we still will have to pay 3,000 at some point. I know our bills for me have been huge on this new plan wich started Oct 1st. From the hernia surgery, 2 full days in hospital then, and total of 13 in December,plus all the medical tests,CT scan's, X-rays,ultrasounds, the Radiation 30 treatments. Sheesh!
  • lanie940
    lanie940 Member Posts: 490
    pgrace35 said:

    Health insurance issue
    As if cancer isn't stressful enough, money issue and insurance coverage just adds to things. As you said, call your insurance company Monday, find out what they are going to cover. Then call the office/hospital of whom ever is doing your surgery and set up a payment plan. I'm up againest a new premium payment now that it's the first of the year, it's $3,000.00, I don't have that,and I start radiation tomorrow, in fact I'm still paying off the hospital from my last premium from my surgery. Also ask the hospital if there are any financial aid programs they may offer. The hospital I went through has a organinzation that helps pay some of your big monthly bills so you can put money towards these expenses if you qualifiy.
    Take care of yourself, do what you have to do,it's too important not too. Pay them what you can afford monthly and just remember it's only money, your health is far more important.

    The new out of pocket for my
    The new out of pocket for my husband's policy I'm on is also 3,000. It had been 1,000. But, the company he works for took out a secondary policy, so in the end it's only 1270 out of pocket. We send in the claims to the secondary, and they riemburse, we still will have to pay 3,000 at some point. I know our bills for me have been huge on this new plan wich started Oct 1st. From the hernia surgery, 2 full days in hospital then, and total of 13 in December,plus all the medical tests,CT scan's, X-rays,ultrasounds, the Radiation 30 treatments. Sheesh!
  • mariam_11_09
    mariam_11_09 Member Posts: 691
    lanie940 said:

    Some Dr.s and Hospitals will
    Some Dr.s and Hospitals will accept what the Ins will pay. the hospital Network I am in does that as from what I have been told. Ins companies really stingy in the percentage they actually pay for the services provided to you. I hear so many complaints about the Government run ins like Medicare and Medicade, but Ins companies don't reeimburse a heck of a lot more. They over-pay their CEO's instead!

    I hope things work out for you.

    Thank-you all for you input
    Thank-you all for you input and support. I appreciate it. I really stressed, there is still some concern however I also decided to just 'trust' in God/Allah and know that it is taken care of.

    I am having dinner with some friends tonight, her and her husband want to strategize with me on this situation. The husband has even offered to come with me to talk to the plastic surgeon on Monday ( I have an appointment with him) to see if he in anyway will reduce my portion with it and to talk with financial services to see what kind of a payment plan they can come up with for me. I will also talk to the insurance company tomorrow.

    I just need to keep letting go, letting go and letting go to keep my heart open to allow for the true healing.
  • MAJW
    MAJW Member Posts: 2,510 Member

    Thank-you all for you input
    Thank-you all for you input and support. I appreciate it. I really stressed, there is still some concern however I also decided to just 'trust' in God/Allah and know that it is taken care of.

    I am having dinner with some friends tonight, her and her husband want to strategize with me on this situation. The husband has even offered to come with me to talk to the plastic surgeon on Monday ( I have an appointment with him) to see if he in anyway will reduce my portion with it and to talk with financial services to see what kind of a payment plan they can come up with for me. I will also talk to the insurance company tomorrow.

    I just need to keep letting go, letting go and letting go to keep my heart open to allow for the true healing.

    Talk with the physicians......
    I would speak DIRECTLY with the physicians.....explain the situation.....ask them if they will accept the insurance payment, as payment in full......considering the situtation you are faced with.....explain EVERYTHING honestly to them.....they may surprise you and agree...

    I wish you well.......
  • Laura_Z
    Laura_Z Member Posts: 2
    MAJW said:

    Talk with the physicians......
    I would speak DIRECTLY with the physicians.....explain the situation.....ask them if they will accept the insurance payment, as payment in full......considering the situtation you are faced with.....explain EVERYTHING honestly to them.....they may surprise you and agree...

    I wish you well.......

    My insurance changed, too
    My insurance had changed on Nov 1st, and I had my surgery on November 30th. Prior to that, my oncological surgeon told me not to get worried about the plastic surgeon, that none of them really participate with any insurance companies, that they work out payment with each insurance company individually.

    Luckily for me, the insurance company that I had prior to the switch had approved the surgery, so when the new carrier balked about the surgeon I was seeing, there was already something in place. So far, so good.

    Hope your surgery has gone well, today.
    I'll keep my fingers crossed for both of us when it comes to having this all work out.

    Best to you,
    **Laura