The @#$%! insurance company

shy violet

Lighthouse_7 said:

OK here goes...I'm at risk
OK here goes...I'm at risk of most of you hating me but I'll have to live with it. For reasons that I experienced first hand,
I wish this country had socialized medicine. I am tired of the huge bills I've received since my dx and they are just MY portion and now (with relatively good insurance) I am told it's gonna cost me 279.00 a month for the new aromatase inhibitor I'm supposed to start.
Aromisin. Well, I can't take it until I can come up with the money and that ladies, breaks my heart.
Sorry, had to rant.
I hate insurance companies!

There is NO reason you
There is NO reason you should get problems on your feelings...not sure if people are upset about socialized medicine so much as how bad our govt will screw it up...thinking of the horrible bureaucratic crap we go through for ANYTHING the govt even touched...too many personal times to count...paperwork, paperwork lost, no office to talk to a person have to go through a call center...deny you because info not recd, oh you faxed three separate times? Can't find, send again, have to open new case now...ooh minimum 8 week wait...blah blah...sad other countries are competent...
when my mom was so I'll from ovarian, the deductibles were too high so the only way she could get her chemo was to dehydrate and then the onc could do as inpatient and it would be covered...sad sad sad

roseyposey333

cindycflynn said:

That SUX!
So sorry you have to deal with this, but it may be resolved more easily than it appears right now. I received a similar letter from my insurance company about the cost of my Oncotype DX test (not nearly as expensive as your radiation, but still). When I contacted the company who submitted the bill to make sure they had the proper coding, etc., they were already submitting the appeal for me. I didn't have to do anything, and the insurance company did pay for it.

There are many reasons, some of which are not even the insurance company's fault, that this might be happening. I'd try calling them first to find out more specifics about why it's being denied, and then call the hospital/facility to see if they're already working on resubmitting it (usually the denial is sent to the medical provider the same time it's sent to you).

I deal with helping employees through this process as part of my job. If you'd like more direct help with this, just send me a PM and I'll be happy to help in any way I can.

Rosey - Marcia is correct about Arimidex being generic now. Hopefully you can find a lower cost option for that.

(((HUGS)))
Cindy

yes, working on all of that
Spoke to my Social Worker at the hospital and she gave me the number of the pharmacutical (sp) and so I will call them. Not sure about the generic brand but thanks for the info.

My mother in law lives in France and has had no problem with any medical costs. They do have the right idea, less stress so a person can get better with the care and meds they need.

R

Lighthouse_7

shy violet said:

There is NO reason you
There is NO reason you should get problems on your feelings...not sure if people are upset about socialized medicine so much as how bad our govt will screw it up...thinking of the horrible bureaucratic crap we go through for ANYTHING the govt even touched...too many personal times to count...paperwork, paperwork lost, no office to talk to a person have to go through a call center...deny you because info not recd, oh you faxed three separate times? Can't find, send again, have to open new case now...ooh minimum 8 week wait...blah blah...sad other countries are competent...
when my mom was so I'll from ovarian, the deductibles were too high so the only way she could get her chemo was to dehydrate and then the onc could do as inpatient and it would be covered...sad sad sad

Thanks shy for saying that.
Thanks shy for saying that. I was afraid everyone would come down on me for believing this, but my daughter was on a school trip to London years ago and had an emergency and they treated her and gave her medicine absolutely free. She always talks about how good they were to her, while I was at home panicking that she was in a foreign country.

Canada, France and so many other countries consider health care a right to their citizens and of course they all can have problems but does anyone in this country, who has had a devastating illness, think for one minute that we don't have problems.
We just have to pay big and have problems which to me, makes them far worse than if they were free.
Thanks again,
I think my rant is officially done.
It's nice to know that I can vent here!
Hugs,
Wanda

Chickadee1955

roseyposey333 said:

yes, working on all of that
Spoke to my Social Worker at the hospital and she gave me the number of the pharmacutical (sp) and so I will call them. Not sure about the generic brand but thanks for the info.

My mother in law lives in France and has had no problem with any medical costs. They do have the right idea, less stress so a person can get better with the care and meds they need.

R

Whenever you have a problem
Whenever you have a problem with an insurance company, especially like being turned over to collections, you need to copy your state Department of Insurance with your complaint. They will immediately contact the insurance company and demand an explanation--with very strict time limitations. If the insurance company fails to adequately or timely respond, they are fined and can even risk losing their license to do business in the state. Every state has one and believe me, the insurance claim examiners and their bosses pay attention. Usually the highest ranking individual in any given claims office keeps tabs on those complaints and makes sure they are answered.

I'm a firm believer in complimenting good behavior/service, but I copy every agency and watchdog I can when I have a major complaint. TV, newspapers. This is Breast Cancer Awareness Month----great time to call your local TV station to tell them what you're dealing with.

Skeezie

Chickadee1955 said:

Whenever you have a problem
Whenever you have a problem with an insurance company, especially like being turned over to collections, you need to copy your state Department of Insurance with your complaint. They will immediately contact the insurance company and demand an explanation--with very strict time limitations. If the insurance company fails to adequately or timely respond, they are fined and can even risk losing their license to do business in the state. Every state has one and believe me, the insurance claim examiners and their bosses pay attention. Usually the highest ranking individual in any given claims office keeps tabs on those complaints and makes sure they are answered.

I'm a firm believer in complimenting good behavior/service, but I copy every agency and watchdog I can when I have a major complaint. TV, newspapers. This is Breast Cancer Awareness Month----great time to call your local TV station to tell them what you're dealing with.

Well Lighthouse I absolutely totally disagree with you
about socialized medicine. Who do you think pays for it? the government? And where do they get the $$$. From the tax payers. All of these countries with socialized medicine pay unbeliveable taxes. The the governmnent decides who gets what. In Canada there are too many stories of people having to wait 6 mo or more for an MRI so they come over here to get taken care of immediately. I just read in teh Windsor Star, a Windsor Ontario newspaper (we live right across the river from Canada) that there was something like a ratio of 1 doc to 100,000 patients. They have all these little prompt care clinics where people go when they are sick but that they are very concerned that people are not getting reguilar preventative care. No such thing as a "free" lunch. I rmember a girl, from Canada, on this board a few months ago asking what Neulasta was that we were all talking about. Another thought, the government screws up every program they try and have, take a look at the schools, Medicare, Social Security and jon and on....do ya really think they could do a good job? No way.

I'll continue to fight with Medicare and BC/BS and get good care instantly. I read last Jan that a Mayo Family Clinic in Arizona was not going to see anymore Medicare patients after 1-1-10 because of the Medicare cuts. They are a family practice clinic. Oh and I have neighbors who lived in Sweden for 2 years and just got back 2 yrs ago, they didn't have a lot of good stuff to say about their "free" medical care. Oh and in Canada, you still pay a monthly premium for health care along with very high taxes. Like 17 or 18% on merchandise in Ontario. And that doesn't include any other tax. Nothing is free.

Marcia527

Skeezie said:

Well Lighthouse I absolutely totally disagree with you
about socialized medicine. Who do you think pays for it? the government? And where do they get the $$$. From the tax payers. All of these countries with socialized medicine pay unbeliveable taxes. The the governmnent decides who gets what. In Canada there are too many stories of people having to wait 6 mo or more for an MRI so they come over here to get taken care of immediately. I just read in teh Windsor Star, a Windsor Ontario newspaper (we live right across the river from Canada) that there was something like a ratio of 1 doc to 100,000 patients. They have all these little prompt care clinics where people go when they are sick but that they are very concerned that people are not getting reguilar preventative care. No such thing as a "free" lunch. I rmember a girl, from Canada, on this board a few months ago asking what Neulasta was that we were all talking about. Another thought, the government screws up every program they try and have, take a look at the schools, Medicare, Social Security and jon and on....do ya really think they could do a good job? No way.

I'll continue to fight with Medicare and BC/BS and get good care instantly. I read last Jan that a Mayo Family Clinic in Arizona was not going to see anymore Medicare patients after 1-1-10 because of the Medicare cuts. They are a family practice clinic. Oh and I have neighbors who lived in Sweden for 2 years and just got back 2 yrs ago, they didn't have a lot of good stuff to say about their "free" medical care. Oh and in Canada, you still pay a monthly premium for health care along with very high taxes. Like 17 or 18% on merchandise in Ontario. And that doesn't include any other tax. Nothing is free.

We know Canadians and they
We know Canadians and they love their health care. Taxes are a bit higher to cover it but everybody is covered and if you get sick you don't lose everything you have. They said elective stuff you have to wait for but if it's needed you don't.

Nothing is free is right tho. But $250 or more for a months needed medication is not right. IMO. And the private pill people will say it's payback for research.

I'm not one to debate so I won't say more. But I have to defend the Canadians. I love them! We shouldn't be passing laws to prevent us from buying medicine from there.

Skeezie

Marcia527 said:

We know Canadians and they
We know Canadians and they love their health care. Taxes are a bit higher to cover it but everybody is covered and if you get sick you don't lose everything you have. They said elective stuff you have to wait for but if it's needed you don't.

Nothing is free is right tho. But $250 or more for a months needed medication is not right. IMO. And the private pill people will say it's payback for research.

I'm not one to debate so I won't say more. But I have to defend the Canadians. I love them! We shouldn't be passing laws to prevent us from buying medicine from there.

Well I deleted my answer and now have to try and remember
what I said....we have spent a lifetime enjoying Canada and have many Canadian friends as well and no everyone's story is so rosey.

I shudder at the thought of an inept, overblown government agency making my decisions for me and then taxing me to death for the privilege of that aggrevation. Medicare is bad enough. Before Medicare I never had a single problem and BC/BS was wonderful and easy to deal with...not anymore. I have two issues I currently have to deal with, they are minor but my blood is boiling already and it's a doctors office and a lab and mammorgraphy that are at fauilt.

I really don't like getting into any political discusions on this board, we all have enough to deal with without that getting between us, but that is a real hot button issue for me. We should all be careful what we wish for cause we mite get it and then it's too late. But to each his own.

faith_trust_and_a_little_bit_of_chemotherapy

Skeezie said:

Well I deleted my answer and now have to try and remember
what I said....we have spent a lifetime enjoying Canada and have many Canadian friends as well and no everyone's story is so rosey.

I shudder at the thought of an inept, overblown government agency making my decisions for me and then taxing me to death for the privilege of that aggrevation. Medicare is bad enough. Before Medicare I never had a single problem and BC/BS was wonderful and easy to deal with...not anymore. I have two issues I currently have to deal with, they are minor but my blood is boiling already and it's a doctors office and a lab and mammorgraphy that are at fauilt.

I really don't like getting into any political discusions on this board, we all have enough to deal with without that getting between us, but that is a real hot button issue for me. We should all be careful what we wish for cause we mite get it and then it's too late. But to each his own.

Dear Meena...
I know you are absolutely correct about this...hospital, authorization, the whole C cup! Thank you, too, for reminding me to breath. That was the best advice I received from a couple of survivors when I was first diagnosed.

My only born would make a crappy indentured servant, she has yet to master toilet cleaning skills. I'm more annoyed than ticked off... I just needed to get it off what remains of my chest.

GenieM27

IMRT Appeal
My IMRT authorization was denied before I started my treatments. It was by Anthem. I was really mad. They said it was investigational/experimental radiation too. My tumor was removed before radiation. My tumor was located in the 7p position next to my chest wall which is close to my heart and lungs. I also had the expanders too. I had someone look up the clinical Milliman Guidelines (which all healthcare use) copied them and submitted with my appeal. I was so lucky that the office manager in my doctors office took care of everything. They did overturn their decision, and my radiation was approved. I agree, the paper work is worse when you are going through this illness. Good luck I hope all works out well for you in everything!

Hugs,
Genie

faith_trust_and_a_little_bit_of_chemotherapy

GenieM27 said:

IMRT Appeal
My IMRT authorization was denied before I started my treatments. It was by Anthem. I was really mad. They said it was investigational/experimental radiation too. My tumor was removed before radiation. My tumor was located in the 7p position next to my chest wall which is close to my heart and lungs. I also had the expanders too. I had someone look up the clinical Milliman Guidelines (which all healthcare use) copied them and submitted with my appeal. I was so lucky that the office manager in my doctors office took care of everything. They did overturn their decision, and my radiation was approved. I agree, the paper work is worse when you are going through this illness. Good luck I hope all works out well for you in everything!

Hugs,
Genie

Yep, Anthem
Thanks, Genie, I appreciate the information regarding Milliman Guidelines. I will most definitely mention it when I see the radiologist next week for my first follow up.

John_32

Skeezie said:

Well I deleted my answer and now have to try and remember
what I said....we have spent a lifetime enjoying Canada and have many Canadian friends as well and no everyone's story is so rosey.

I shudder at the thought of an inept, overblown government agency making my decisions for me and then taxing me to death for the privilege of that aggrevation. Medicare is bad enough. Before Medicare I never had a single problem and BC/BS was wonderful and easy to deal with...not anymore. I have two issues I currently have to deal with, they are minor but my blood is boiling already and it's a doctors office and a lab and mammorgraphy that are at fauilt.

I really don't like getting into any political discusions on this board, we all have enough to deal with without that getting between us, but that is a real hot button issue for me. We should all be careful what we wish for cause we mite get it and then it's too late. But to each his own.

It's sounds like you are
It's sounds like you are extremely dissatisfied with the current U.S. healthcare system, so I am not clear why you think a national health insurance program, as is in place in virtually every other industrialized nation in the world, would be such a nightmare. Two people in my life are directly affected by this, both stage IV breast cancer: my wife (Canadian) and my mother (American). My wife has received absolutely first-class medical attention from the very beginning at major state-of-the-art hospitals in Toronto, with very attentive care and no discernible "waiting periods" that Americans are always talking about, and of course, all of this at zero cost to her. Not once in all of our numerous visits to doctors and hospitals did we ever see a bill, nor was any kind of supplementary insurance that you speak about every required. EVERYTHING WAS TOTALLY FREE. EVERYTHING. Even free transport to the hospital if we wanted it. And no paperwork was required. The only thing she was ever asked for was her Ontario Health Insurance Plan card-that's it. Contrast this with my mother, in New York, who lost her job in the recession, as did her husband, and now has no health insurance at all, and can not even qualify for medicaid because she is not pregnant, over 65, or permanently disabled. Anyone who thinks this second (American) scenario is in some way superior to the first (Canadian) scenario might want to educate themselves more on the subject, and note that "might" is not spelled m-i-t-e. I apologize if that sounds judgmental, but this has been very personally devastating for me and I think that it is only fear and ignorance that has prevented this country from joining the rest of the world in having a truly comprehensive, ethical, and advanced health care system.

Skeezie

faith_trust_and_a_little_bit_of_chemotherapy said:

Yep, Anthem
Thanks, Genie, I appreciate the information regarding Milliman Guidelines. I will most definitely mention it when I see the radiologist next week for my first follow up.

Well John I certainly know the difference between might and mite
Don't you think you are nit picking a bit? I may shorten certain words but certainly use correct grammar....geeesh. I would never make fun of you and after being very supportive of you all this time I am surprised at being made fun of by you. I gave my opinion and if it differs with yours and others, well that's ok. I'm not unhappy with our system, I am unhappy with Medicare, the big government system and hate to see if get bigger.

Nothing is free, our friends in Sweden paid 50% of their pay in taxes. There are ways of improving a system that don't include total take over.

Skeezie

Skeezie said:

Well John I certainly know the difference between might and mite
Don't you think you are nit picking a bit? I may shorten certain words but certainly use correct grammar....geeesh. I would never make fun of you and after being very supportive of you all this time I am surprised at being made fun of by you. I gave my opinion and if it differs with yours and others, well that's ok. I'm not unhappy with our system, I am unhappy with Medicare, the big government system and hate to see if get bigger.

Nothing is free, our friends in Sweden paid 50% of their pay in taxes. There are ways of improving a system that don't include total take over.

John, I am very well educated on this subject but this is not
the place for a political discussion.

I understand your distress and your situation and certainly we all have our own agonies with this horrible Beast. But to quote you last June, I am a bit offended by your ragging on me and making fun of my shortcut of "might". Why would you do that?

John_32

Skeezie said:

John, I am very well educated on this subject but this is not
the place for a political discussion.

I understand your distress and your situation and certainly we all have our own agonies with this horrible Beast. But to quote you last June, I am a bit offended by your ragging on me and making fun of my shortcut of "might". Why would you do that?

Well I now regret mentioning
Well I now regret mentioning the part about your spelling if only because it seems to have distracted you from my larger point which you didn't really seem to address. I'm really not a stickler for typos on message boards, as I know I've committed more than my share, but it didn't seem like you were accidentally leaving out a letter, just that you were spelling it with completely incorrect letters, and it added to my central criticism about people not really knowing what they are talking about when they write about national health insurance programs in this second-hand manner, i.e., the ubiquitous "friends" from europe or canada who once had a bad experience. Curiously, you said this is not the place for political discussion more than once, and yet wrote something so overtly political, and on an issue I feel very strongly about. I agree that "we all have our own agonies" who come to this board, but some part of that agony, for many, is trying to cope with a life-threatening illness in a nation that does not guarantee healthcare to all of its citizens. Perhaps politics should play more of a role in these boards, since political decisions made by people in power who are deeply uninformed about nationalized health insurance plans, and obscenely beholden to the interests of the billion-dollar private health insurance industry, have devastating consequences for people who have cancer in this country but have lost their jobs or cannot afford decent private insurance. Can you really compare to the two scenarios I presented with my wife and my mother and say that the system in which my mother is in (or rather excluded from) somehow has more integrity as a healthcare system? And as to your point about taxes--the same people who are criticizing healthcare reform are also the same people obsessed with tax cuts and frankly give off the impression that ANY amount of tax is some kind of abomination. The fact of the matter is that Americans already spend much more on health insurance than people in other countries, in addition to paying a large amount in taxes, and yet, uniquely in the industrialized world, are not guaranteed healthcare.

Skeezie

John_32 said:

Well I now regret mentioning
Well I now regret mentioning the part about your spelling if only because it seems to have distracted you from my larger point which you didn't really seem to address. I'm really not a stickler for typos on message boards, as I know I've committed more than my share, but it didn't seem like you were accidentally leaving out a letter, just that you were spelling it with completely incorrect letters, and it added to my central criticism about people not really knowing what they are talking about when they write about national health insurance programs in this second-hand manner, i.e., the ubiquitous "friends" from europe or canada who once had a bad experience. Curiously, you said this is not the place for political discussion more than once, and yet wrote something so overtly political, and on an issue I feel very strongly about. I agree that "we all have our own agonies" who come to this board, but some part of that agony, for many, is trying to cope with a life-threatening illness in a nation that does not guarantee healthcare to all of its citizens. Perhaps politics should play more of a role in these boards, since political decisions made by people in power who are deeply uninformed about nationalized health insurance plans, and obscenely beholden to the interests of the billion-dollar private health insurance industry, have devastating consequences for people who have cancer in this country but have lost their jobs or cannot afford decent private insurance. Can you really compare to the two scenarios I presented with my wife and my mother and say that the system in which my mother is in (or rather excluded from) somehow has more integrity as a healthcare system? And as to your point about taxes--the same people who are criticizing healthcare reform are also the same people obsessed with tax cuts and frankly give off the impression that ANY amount of tax is some kind of abomination. The fact of the matter is that Americans already spend much more on health insurance than people in other countries, in addition to paying a large amount in taxes, and yet, uniquely in the industrialized world, are not guaranteed healthcare.

Let me ask you something John, what I if I was actually
spelling might with incorrect letters because I didn't know better? Does that mean me, or anyone else who used "there" instead of "their" etc. should be taken to task and have fun made of them?

No, I'm not distracted from your larger point, I'm just not going to get into a heated discussion with you. I gave my opinion and you have given yours....you will never convince me, nor I you. There are other discussion boards for these types of posts. This board is for all of us to find comfort and a soft place to fall. A place to exchange information, laugh and cry with each other, a place to truly let our hair down about our feelings of fear, depression and to report our good news and joys. I realize you haven't had any good news or joys for quite a while and I am praying that will change.

Brooklynchele

roseyposey333 said:

I can relate
Just got a bill today stating that my treatment was "out of network", uuuggghh, I know the hospital checked it all out before my treatment.

Also, found out that my insurance company will not pay for my Arimidex. $250 a month for 5 years, well isn't that great.

On a job search now to make some $$ for all the bills. The party is over,if you can call breast cancer/treatment a party. had to leave my job because I moved to a different town and haven't been strong enough to start a new job but time is up, reality bites. R

Help with payment for your Arimidex
You need to go to: http://www.rxassist.org/pap-info/company_detail.cfm?CmpId=5
The drug company will help you pay for their drug or will give it to you for free.

Hugs,
Michele

Brooklynchele

roseyposey333 said:

yes, working on all of that
Spoke to my Social Worker at the hospital and she gave me the number of the pharmacutical (sp) and so I will call them. Not sure about the generic brand but thanks for the info.

My mother in law lives in France and has had no problem with any medical costs. They do have the right idea, less stress so a person can get better with the care and meds they need.

R

Website for Arimidex
http://www.rxassist.org/pap-info/company_detail.cfm?CmpId=5

Brooklynchele

roseyposey333 said:

yes, working on all of that
Spoke to my Social Worker at the hospital and she gave me the number of the pharmacutical (sp) and so I will call them. Not sure about the generic brand but thanks for the info.

My mother in law lives in France and has had no problem with any medical costs. They do have the right idea, less stress so a person can get better with the care and meds they need.

R

Website for Arimidex - TO GET DRUG FOR FREE
http://www.rxassist.org/pap-info/company_detail.cfm?CmpId=5

John_32

Brooklynchele said:

Website for Arimidex - TO GET DRUG FOR FREE
http://www.rxassist.org/pap-info/company_detail.cfm?CmpId=5

Thank you for this link.
Thank you for this link. That is the drug my mother takes, though the latest results have shown that her cancer markers are no longer decreasing on this drug, but the last time she was able to see a doctor she was still advised to keep taking it and await more tests. I guess now that the patent has expired Astra-Zeneca can pretty much give it away to poor people since they can't profit so much on it anymore.

John_32

Skeezie said:

Let me ask you something John, what I if I was actually
spelling might with incorrect letters because I didn't know better? Does that mean me, or anyone else who used "there" instead of "their" etc. should be taken to task and have fun made of them?

No, I'm not distracted from your larger point, I'm just not going to get into a heated discussion with you. I gave my opinion and you have given yours....you will never convince me, nor I you. There are other discussion boards for these types of posts. This board is for all of us to find comfort and a soft place to fall. A place to exchange information, laugh and cry with each other, a place to truly let our hair down about our feelings of fear, depression and to report our good news and joys. I realize you haven't had any good news or joys for quite a while and I am praying that will change.

If you are going to "make
If you are going to "make fun" of an entire health care system, used in countries throughout the modern world, that guarantees healthcare to millions of people, especially the poor or lower income, who would not otherwise have healthcare, with a passing observation about taxes by a Swedish neighbor of yours, then yes, I am at least going to correct the spelling in which you attempt to do so. You *might* not be convinced of my view that all human beings, regardless of economic status, should have equal access to healthcare, but it seems I have at least convinced you of the correct spelling of *might*. It's a much smaller victory, but a step toward progress.