Financial resources for help with my cancer

deborahwacker
deborahwacker Member Posts: 1 *
in Lung Cancer #1

I have stage 4 adenocarcinoma where I have a lung tumor, brain tumor, and metastisized to the lymphatic system. This was my diagnosis 2 yrs ago. With me the drug Ketruda is what I have to maintain the rest of what life I have left. The insurance companys quit paying saying they only would pay for 2 years. My heart broke especially when I didn't know anything about it. To know insurance companies control whether you live or die is outrageous. I paid the best insurance for many yrs of my life. I mean how does one deal with this? PLEASE help me!!!

Comments

  • eDivebuddy
    eDivebuddy Member Posts: 90 Member
    #2

    I'm sorry you're dealing with this. insurance battles can be exhausting, especially when it comes to covering long-term treatments like Keytruda. From what I've seen, many insurance companies refuse coverage after 2 years, which can create serious challenges. Since you mentioned this issue, I’m assuming you might not be on Medicare yet. If that’s the case, I wanted to share a few options that might help.

    At stage 4, you may qualify for Social Security Disability Insurance (SSDI). Lung cancer at that stage is eligible for expedited processing under the Compassionate Allowance program. This can speed up both approval and benefits.

    Getting SSDI also starts the clock for Medicare eligibility—it typically kicks in after 2 years on disability. However, SSDI does have a work requirement, meaning you must have worked and paid Social Security taxes for at least 5 out of the last 10 years. If time is tight, you may want to apply sooner rather than later.

    Additionally, depending on your state and income, you might also be able to apply for Medicaid as a secondary insurance.

    Finally, I strongly recommend reaching out to your hospital’s financial counselor or benefits coordinator. I have a financial navigator who has been a lifesaver when it comes to dealing with insurance and finding programs that help with copays and coverage gaps.

    Regarding assistance from Merck:

    Merck Access Program: This program offers co-pay assistance to eligible, privately insured patients. Once enrolled, patients pay the first $25 of their co-pay per infusion, with a maximum annual benefit of $25,000.

    Merck Patient Assistance Program: This program provides certain medicines and adult vaccines free of charge to eligible individuals who do not have insurance or whose insurance does not cover their prescription Merck products.

    I've been on Keytruda for 4 and a half years, and the support from these programs has been invaluable. When things work smoothly, it's such a burden and stress reducer not to have to even think about it.

    It’s infuriating when cancer centers, especially those with financial and benefits experts, fail to explain crucial things like SSDI, Medicare, and insurance transitions right from the start. This isn't just a minor oversight; it’s a failure to provide essential support that could have saved you from unnecessary stress and financial hardship.

    By now, you should have been well into the Medicare transition process, but instead, you're stuck fighting an insurance company over something entirely preventable. This lack of guidance can allow a patient to fall through the cracks when they’re already at their most vulnerable.

    Even if the plan had been to stop Keytruda after 2 years, the cancer center’s role is not just to administer medicine. It's about patient care, both during and after treatment. Unfortunately, in this case, your center has failed you miserably.

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