Payment for clinical trials
Last year when I went to Yale, I was pleading to be treated with IL-2 as I thought that was my only chance for survival. As you all know, I was offered a placement in the MDX-1106 trial if I qualified. So, I signed the protocal committment which set requirements that I had to agree with. Scans, biopsies, blood work. In return I get infusions every 3 weeks for up to 4 years if necessary, depending on my progress or lack thereof. Not only was I told that the sponsor, Bristol Meyer Squibb would provide my treatment free of charge but there is a statement in the contract that says, quote,
"You will be responsible for regular copayments associated with your office visits through your insurance company. The study drug, study-related procedures, and study visits will be provided at no charge to you or your insurance company."
So, since spring, I have been billed thousands of dollars for my care. So I disputed the bills but I have paid them because the bills had been turned over to a collections agency and I don't want my credit rating ruined. Now, I keep fighting with Smilow cancer hospital of Yale that the bills should be going to Bristol Meyers Squibb and not me. I do want Yale to be paid and BMS should be more than happy to pay them. For one, that is the agreement. 2, I am proving that this drug is going to make them millions and millions of dollars.
How can I be wrong? They say that I misunderstand the agreement, that it is confusing and that I am wrong. So after no luck with their billing dept., I have gone above them to hospital administration with my perspective. I am waiting for a decision but expect that they will not support my claim. So I am preparing for a fight.
I would never have had a hesitation to pay for all my care if I knew MDX-1106 would save my life. It's not the money. I want that to be clear. I contend they are not billing properly. I expect that the Yale lawyers will bang their heads together for awhile and determine that "at no charge" really means that it costs money. They don't seem to understand their own billing process.
So, has anyone else been given a bait and switch? And what would be the contract law perspective? I don't want to risk my participation in the trial. I want the billing to be corrected and then be reimbursed. Why should that be an issue? I have the support from my caregivers at the cancer center just not the billing dept. I think they are being lazy.I am standing my ground until proven wrong.
Comments
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Payments
Fox, of course I hope you prevail.
Who are the parties to the contract?
From what you say, it sounds as though neither BMS nor anyone's lawyers are to blame, but solely the billing department of the Hospital. Did you challenge the issue of bills to you at the outset and, if so, what reply did you get from the billing dept?
In the bit of documentation you've quoted, what do you take to be the referent(s) of "You will be responsible for regular copayments associated with your office visits"? Are the bills you've been sent for things outwith the "study drug, study-related procedures, and study visits"? (If so, perhaps they're justified.)
Assuming not, then it sounds as though you've hit the nail on the head in ascribing the mess to laziness on the part of the billing dept. Have you approached anyone at BMS on the matter? As you say, they have much to gain from your exemplary participation in their trial and they also have much to lose by bad publicity. I guess they'd be very happy to pick up the tab in these circumstances and I think you should, indeed, stand your ground.0 -
XO Fox
Here's what my document states.
There is no cost to you for the study doctors' fees for study clinic evaluations, procedures, and tests required to be done solely for study purposes. All bills for routine care (things you would have done even if you were not taking part in this study) will be billed to you or your insurance company. You or a third party will be responsible for the costs of all study doctor's visits, physical exams, lab testing, medications, x-rays, scanning procedures and other procedures used in this study, that are not incurred solely for research purposes. You will be responsible for any deductibles or co-payments required by your insurance company or third party payer. Some insurance companies and third party payers may not pay for treatment or lab tests conducted as part of a research study, including hospitalization costs. If your insurance company does not pay for these costs, you will be responsible for them. However, you should be aware that certain health benefit plans are required to cover care provided in the course of certain research studies. You should consult with your health benefit plan to determine whether the costs of care incurred because of taking part int his study are covered.
For more information on insurance coverage for clinical research studies, you can visit the Nation Cancer Institute's website at http://cancer.gov/clinical trials/understanding/insurance-coverage
Like you, I never considered NOT being in the trial if I was accepted. I am just "letting God take care of it" right now and have not yet had any snafus.
I have never received a bill from Sarah Cannon. I have Blue Cross Blue Shield insurance.0 -
billingTexas_wedge said:Payments
Fox, of course I hope you prevail.
Who are the parties to the contract?
From what you say, it sounds as though neither BMS nor anyone's lawyers are to blame, but solely the billing department of the Hospital. Did you challenge the issue of bills to you at the outset and, if so, what reply did you get from the billing dept?
In the bit of documentation you've quoted, what do you take to be the referent(s) of "You will be responsible for regular copayments associated with your office visits"? Are the bills you've been sent for things outwith the "study drug, study-related procedures, and study visits"? (If so, perhaps they're justified.)
Assuming not, then it sounds as though you've hit the nail on the head in ascribing the mess to laziness on the part of the billing dept. Have you approached anyone at BMS on the matter? As you say, they have much to gain from your exemplary participation in their trial and they also have much to lose by bad publicity. I guess they'd be very happy to pick up the tab in these circumstances and I think you should, indeed, stand your ground.
I knew I could count on hearing from you Tex.
I signed the consent. Also signed by the trial nurse coordinator. She was the one who first informed me that BMS covered the MDX program. I had given her all my bills starting back in the spring when they first began to arrive. She said she would look into it as it was not correct. There were issues of my deductibles but I insisted there was no deductible if my insurance wasn't paying for it. That nurse has since left the hospital and follow up had been dropped so I started to directly contact the billing dept. which of course is off campus. Most phone calls have been left in voice mails. Others have resulted in being told that they are looking into it but they don't have all the information necessary. And that I am wrong and that the contract is ambiguous. I do pay for copayments for my visits but that is different. The contract is stamped and approved by the "Yale University Human Investigation Committee".
The bills started right off for my biopsies, scans, and even "chemo" as billing refers to my infusions. They obviously don't even have a proper billing code for infusions. I happily have paid for other services such as my skin biopsies and surgical procedures for removal of my skin cancers. None of which is related to the trial.
I have sent an email to BMS but they sent me a message saying, "thank you for your time to contact us. We do read all emails but due to an overwhelming amount of them we do not answer each one..Gee thanks.
Now the thing is that if I don't follow the protocol, then I can be dropped from the study. Therefore ALL requirements that I must meet are part of the protocol. That includes the biopsies, scans and keeping all my appointments and not skipping infusions. that means "The study drug(infusions),study-related procedures(biopsies, blood work and scans) and study visits will be provided to you at NO CHARGE to you or your insurance company. ?no?0 -
Thanks Paula.pjune127 said:XO Fox
Here's what my document states.
There is no cost to you for the study doctors' fees for study clinic evaluations, procedures, and tests required to be done solely for study purposes. All bills for routine care (things you would have done even if you were not taking part in this study) will be billed to you or your insurance company. You or a third party will be responsible for the costs of all study doctor's visits, physical exams, lab testing, medications, x-rays, scanning procedures and other procedures used in this study, that are not incurred solely for research purposes. You will be responsible for any deductibles or co-payments required by your insurance company or third party payer. Some insurance companies and third party payers may not pay for treatment or lab tests conducted as part of a research study, including hospitalization costs. If your insurance company does not pay for these costs, you will be responsible for them. However, you should be aware that certain health benefit plans are required to cover care provided in the course of certain research studies. You should consult with your health benefit plan to determine whether the costs of care incurred because of taking part int his study are covered.
For more information on insurance coverage for clinical research studies, you can visit the Nation Cancer Institute's website at http://cancer.gov/clinical trials/understanding/insurance-coverage
Like you, I never considered NOT being in the trial if I was accepted. I am just "letting God take care of it" right now and have not yet had any snafus.
I have never received a bill from Sarah Cannon. I have Blue Cross Blue Shield insurance.
I do understand the concept of "routine care" that me and my insurance co. are responsible for. I think that is a major part of their argument. I understand. But they send bills to my insurance. They collect a partial payment or a denial, then bill me for the remainder. Including my "Chemo" which insurance wouldn't pay as it is a non approved FDA drug.
My contract only has that one quote I mentioned re:my responsibility for copayments and all else is it no charge. I guess they left alot out.
Additional costs are my responsibility. I know. For example, it seems that when I was recieving radiation, they didn't properly get my ins. auth. so it was denied and I have recieved a $30,000 bill for that too!....Radiation was not done at Yale. So that is not their responsibility.
Here is another pisser. My insurance company changed some time this spring. This has meant that I had a deductible from my last insurance for 2012. Then another deductible to meet with my new insurance. That was a quick $5G down the drain. Oh well. At least my Harley is paid for. And I know how to camp with it. So by summer you can reach me at Pine Hollow campground after I sell my house.
And I like your new picture. I will work on getting a new one up also. Gotta figure it out. Don't even know how I put mine up the first time.0 -
Obama Carefoxhd said:Thanks Paula.
I do understand the concept of "routine care" that me and my insurance co. are responsible for. I think that is a major part of their argument. I understand. But they send bills to my insurance. They collect a partial payment or a denial, then bill me for the remainder. Including my "Chemo" which insurance wouldn't pay as it is a non approved FDA drug.
My contract only has that one quote I mentioned re:my responsibility for copayments and all else is it no charge. I guess they left alot out.
Additional costs are my responsibility. I know. For example, it seems that when I was recieving radiation, they didn't properly get my ins. auth. so it was denied and I have recieved a $30,000 bill for that too!....Radiation was not done at Yale. So that is not their responsibility.
Here is another pisser. My insurance company changed some time this spring. This has meant that I had a deductible from my last insurance for 2012. Then another deductible to meet with my new insurance. That was a quick $5G down the drain. Oh well. At least my Harley is paid for. And I know how to camp with it. So by summer you can reach me at Pine Hollow campground after I sell my house.
And I like your new picture. I will work on getting a new one up also. Gotta figure it out. Don't even know how I put mine up the first time.
Cant wait for universal health care to kick in so everyone can recieve the same healthcare without having to worry about how to pay.0 -
Don't know...Limelife50 said:Obama Care
Cant wait for universal health care to kick in so everyone can recieve the same healthcare without having to worry about how to pay.
if you meant to be funny, but I am LMAO!!0 -
yesgarym said:Don't know...
if you meant to be funny, but I am LMAO!!
A little sarcastist and yes funny0 -
Health careLimelife50 said:yes
A little sarcastist and yes funny
I'd assumed Mike's remark to be in all seriousness. Is there widespread cynicism in The States about a goal of universal healthcare, or at least, greater eequality of access?0 -
Pipe dreamTexas_wedge said:Health care
I'd assumed Mike's remark to be in all seriousness. Is there widespread cynicism in The States about a goal of universal healthcare, or at least, greater eequality of access?
American politics prevent common sense from dictating policy. Universal health care would be socialism and therefore not likely to be achieved in the U.S.0 -
Cynicism...Texas_wedge said:Health care
I'd assumed Mike's remark to be in all seriousness. Is there widespread cynicism in The States about a goal of universal healthcare, or at least, greater eequality of access?
Speaking only from personal experience as an employer, and not wishing to start any arguments, I'll state the following. My cynicism comes from the fact that from inception in 2011 to full implementation in 2014 the so called "Affordable" Healthcare Act (aka Obama Care) will have doubled the premiums I pay to provide this already expensive benefit to my employees, and this is true for every employer I have talked to. This makes us less and less competitive in the world market place and only worsens the situation as the number of employed declines and the number of those in need increases. I have no axe to grind with the need for reform, but simply sticking it to those that are left paying taxes is not going to work IMHO.0 -
Something needs to be donegarym said:Cynicism...
Speaking only from personal experience as an employer, and not wishing to start any arguments, I'll state the following. My cynicism comes from the fact that from inception in 2011 to full implementation in 2014 the so called "Affordable" Healthcare Act (aka Obama Care) will have doubled the premiums I pay to provide this already expensive benefit to my employees, and this is true for every employer I have talked to. This makes us less and less competitive in the world market place and only worsens the situation as the number of employed declines and the number of those in need increases. I have no axe to grind with the need for reform, but simply sticking it to those that are left paying taxes is not going to work IMHO.
I have neighbors who were given a golden handshake when a local division of General Motors moved. They put in 20 years of employment and have not had to work since the early 80's. Full benefits. Both have 3 vehicles, including corvette, $50k pickup, and 2 cadillacs. They have cost of living adjustments that keep them ahead of us in income. AND full medical for them and families.
In our case my wife is paying a $1,000/month for our health insurance on top of our current medical bills. That's insane. And we work in health care. But those on welfare not only get housing, food, cellphones, cable tv, and all health care services for free,they get free taxi service to appts. How does anything in health care make sense?
My brother in law retired from the state after 20 years service at 47 years old. Full benefits and health care at no cost. He is now 75 years old. They paid for my sisters dialysis for years. So every working person is already being unfairly taxed so that others can get a free ride. Somehow there needs to be a balance.
And how does one justify CEO's making 100x the hourly wage of front line workers? Especially Insurance CEO's bringing down millions a year yet deneying basic coverage for it's members?0 -
HiLimelife50 said:Obama Care
Cant wait for universal health care to kick in so everyone can recieve the same healthcare without having to worry about how to pay.
I spelled sarcastic incorrectly but oh well it was late.I had started a thread a few months back on this same subject of health care and how i feel people with health insurance are more welcome than people without.Here i believe most health facilities here are high profit buisnesses that overcharge and yes sure there are free clinics and even a free county hospital in my county but you to travel long distances and then wait long hours to get any medical attention.Something really does need to be done in this country so everyone has access to the same qaulity healthcare if not thousands upon thousands of people either suffer or lose their lives due to the lack of qaulity health care for people without health insurance.0 -
Something needs to be done...foxhd said:Something needs to be done
I have neighbors who were given a golden handshake when a local division of General Motors moved. They put in 20 years of employment and have not had to work since the early 80's. Full benefits. Both have 3 vehicles, including corvette, $50k pickup, and 2 cadillacs. They have cost of living adjustments that keep them ahead of us in income. AND full medical for them and families.
In our case my wife is paying a $1,000/month for our health insurance on top of our current medical bills. That's insane. And we work in health care. But those on welfare not only get housing, food, cellphones, cable tv, and all health care services for free,they get free taxi service to appts. How does anything in health care make sense?
My brother in law retired from the state after 20 years service at 47 years old. Full benefits and health care at no cost. He is now 75 years old. They paid for my sisters dialysis for years. So every working person is already being unfairly taxed so that others can get a free ride. Somehow there needs to be a balance.
And how does one justify CEO's making 100x the hourly wage of front line workers? Especially Insurance CEO's bringing down millions a year yet deneying basic coverage for it's members?
I totally agree and I think you start with putting all politicians and government employees back in the boat with the rest of us. You want reform, take away their, self instituted, tax payer paid for, perks and entitlements, take away the bloated reelection accounts and contributions, limit income to a reasonable sum and give them access only to the same healthcare and retirement systems as those they represent, and let them pay for it out of their pockets like the rest of us. There seems to be a large misconception that the government has its own money, or a lack of understanding that whatever the government spends, no matter on what, it comes directly, dollar for dollar, out of the taxpayer's pocket. So when one person gets something for "FREE" from the government it is actually being paid for by taxpayers with additional fees added on for some bureaucrat to manage the transaction. My father used to call it "The inmates running the asylum."0 -
Health careLimelife50 said:Hi
I spelled sarcastic incorrectly but oh well it was late.I had started a thread a few months back on this same subject of health care and how i feel people with health insurance are more welcome than people without.Here i believe most health facilities here are high profit buisnesses that overcharge and yes sure there are free clinics and even a free county hospital in my county but you to travel long distances and then wait long hours to get any medical attention.Something really does need to be done in this country so everyone has access to the same qaulity healthcare if not thousands upon thousands of people either suffer or lose their lives due to the lack of qaulity health care for people without health insurance.
Thanks for the responses guys. It seems clear that the ideals of equal access are being thwarted by disastrous implementation of welfare policy and the "something needs to be done" rings out from all but the freeloaders.
I don't have the temerity to offer opinion on American politics - I just hope matters move in the right direction. I guess the lament about public sector employees being feather-bedded is common to many different societies.0 -
Paradoxical Quote of the Day...Texas_wedge said:Health care
Thanks for the responses guys. It seems clear that the ideals of equal access are being thwarted by disastrous implementation of welfare policy and the "something needs to be done" rings out from all but the freeloaders.
I don't have the temerity to offer opinion on American politics - I just hope matters move in the right direction. I guess the lament about public sector employees being feather-bedded is common to many different societies.
Ben Stein:
"Fathom the hypocrisy of a government that requires every citizen to prove they are insured... but not everyone must prove they are a citizen."
Now add this, "Many of those who refuse, or are unable to prove they are citizens will receive free insurance paid for by those who are forced to buy insurance because they are citizens."0 -
Another great quote...garym said:Paradoxical Quote of the Day...
Ben Stein:
"Fathom the hypocrisy of a government that requires every citizen to prove they are insured... but not everyone must prove they are a citizen."
Now add this, "Many of those who refuse, or are unable to prove they are citizens will receive free insurance paid for by those who are forced to buy insurance because they are citizens."
"Anyone who thinks he can be happy and prosperous by letting the Government
take care of them; better take a closer look at the American Indian."
Henry Ford I0 -
With/Without Health Caregarym said:Another great quote...
"Anyone who thinks he can be happy and prosperous by letting the Government
take care of them; better take a closer look at the American Indian."
Henry Ford I
I agree that people who don't have health care are treated differently/poorly compared to people with. I also believe that much of the time people with Medicaid are treated VERY badly. It seems that if you get medical assistance you are looked at as someone who is getting a "free ride". While I do completely understand that this is very often true (and am just as frustrated by it as the next person) it makes me crazy when I or my family are treated that way. Here's why....
My husband works like 3 whipped dogs and always has. The man never sits down and has busted his behind for the same company for the last 12 years. They do not offer insurance. Up until 2007 (when I was diagnosed with epilepsy) I worked at least 2 and sometimes 3 jobs. I provided our health insurance through my main job as I was the main breadwinner at the time. He works construction, I have management experience and also veterinary technician training and dog training so was able to get higher paying jobs that offered insurance. When I got sick that went down the drain. I lost my jobs, my insurance, everything. We had to sign up for medicaid and for a short time welfare. We were desperate and drowning. BEFORE I got my disability we had reined in our bills and learned to manage on his income so we dropped the food stamps and other benefits and kept only the insurance - despite the social workers constantly telling us we qualified for more. He looked for other jobs, but the market is hard and at least he has a job. I got disability and Medicare, but my kids still needed insurance and so did he (though he constantly tells me he doesn't - that's what duct tape and super glue are for!).
We are still well below poverty level, quite frankly, despite owning a home I adore and having food on the table. We still qualify for all of those extra services but we don't take them because we take only what we really need. I AM looked at differently quite often right after I hand them the second insurance card. The one that pics up what medicare misses. The one that labels me as lazy. The one that says that person is paying for not only my healthcare, but also my food, my clothes, my rent, my electric, my cellphone. No they're not. We pay taxes. He works damned hard and so did I. I'd bet I worked harder between the ages of 13 and 27 than a lot of people did during their whole careers.
Anyway, yes, there needs to be reform, there needs to be change, there needs to be many many things. But a little less judgement sometimes would be a good start IMO.0 -
Caring about health careWolflvr said:With/Without Health Care
I agree that people who don't have health care are treated differently/poorly compared to people with. I also believe that much of the time people with Medicaid are treated VERY badly. It seems that if you get medical assistance you are looked at as someone who is getting a "free ride". While I do completely understand that this is very often true (and am just as frustrated by it as the next person) it makes me crazy when I or my family are treated that way. Here's why....
My husband works like 3 whipped dogs and always has. The man never sits down and has busted his behind for the same company for the last 12 years. They do not offer insurance. Up until 2007 (when I was diagnosed with epilepsy) I worked at least 2 and sometimes 3 jobs. I provided our health insurance through my main job as I was the main breadwinner at the time. He works construction, I have management experience and also veterinary technician training and dog training so was able to get higher paying jobs that offered insurance. When I got sick that went down the drain. I lost my jobs, my insurance, everything. We had to sign up for medicaid and for a short time welfare. We were desperate and drowning. BEFORE I got my disability we had reined in our bills and learned to manage on his income so we dropped the food stamps and other benefits and kept only the insurance - despite the social workers constantly telling us we qualified for more. He looked for other jobs, but the market is hard and at least he has a job. I got disability and Medicare, but my kids still needed insurance and so did he (though he constantly tells me he doesn't - that's what duct tape and super glue are for!).
We are still well below poverty level, quite frankly, despite owning a home I adore and having food on the table. We still qualify for all of those extra services but we don't take them because we take only what we really need. I AM looked at differently quite often right after I hand them the second insurance card. The one that pics up what medicare misses. The one that labels me as lazy. The one that says that person is paying for not only my healthcare, but also my food, my clothes, my rent, my electric, my cellphone. No they're not. We pay taxes. He works damned hard and so did I. I'd bet I worked harder between the ages of 13 and 27 than a lot of people did during their whole careers.
Anyway, yes, there needs to be reform, there needs to be change, there needs to be many many things. But a little less judgement sometimes would be a good start IMO.
Just lately we've had several new members here who have been through a lot but keep their chins up, have the ideal attitude and have penned messages so inspiring that some of us old folks can retire (of course, not including Methuselah, who dates back to the ice age!).
Wolflvr, someone on another thread (Alice, maybe) opined that you will make a lot of friends here and that seems to me to be a very safe call. I, for one, am hoping to hear a lot more from you and to see you getting the breaks you and your Family so richly deserve.0 -
Health ReformWolflvr said:With/Without Health Care
I agree that people who don't have health care are treated differently/poorly compared to people with. I also believe that much of the time people with Medicaid are treated VERY badly. It seems that if you get medical assistance you are looked at as someone who is getting a "free ride". While I do completely understand that this is very often true (and am just as frustrated by it as the next person) it makes me crazy when I or my family are treated that way. Here's why....
My husband works like 3 whipped dogs and always has. The man never sits down and has busted his behind for the same company for the last 12 years. They do not offer insurance. Up until 2007 (when I was diagnosed with epilepsy) I worked at least 2 and sometimes 3 jobs. I provided our health insurance through my main job as I was the main breadwinner at the time. He works construction, I have management experience and also veterinary technician training and dog training so was able to get higher paying jobs that offered insurance. When I got sick that went down the drain. I lost my jobs, my insurance, everything. We had to sign up for medicaid and for a short time welfare. We were desperate and drowning. BEFORE I got my disability we had reined in our bills and learned to manage on his income so we dropped the food stamps and other benefits and kept only the insurance - despite the social workers constantly telling us we qualified for more. He looked for other jobs, but the market is hard and at least he has a job. I got disability and Medicare, but my kids still needed insurance and so did he (though he constantly tells me he doesn't - that's what duct tape and super glue are for!).
We are still well below poverty level, quite frankly, despite owning a home I adore and having food on the table. We still qualify for all of those extra services but we don't take them because we take only what we really need. I AM looked at differently quite often right after I hand them the second insurance card. The one that pics up what medicare misses. The one that labels me as lazy. The one that says that person is paying for not only my healthcare, but also my food, my clothes, my rent, my electric, my cellphone. No they're not. We pay taxes. He works damned hard and so did I. I'd bet I worked harder between the ages of 13 and 27 than a lot of people did during their whole careers.
Anyway, yes, there needs to be reform, there needs to be change, there needs to be many many things. But a little less judgement sometimes would be a good start IMO.
Don’t believe anyone disagrees with the necessity of health care reform. And I think this thread—while spouting many different opinions—reflects that need with a common denominator of frustration, growing frustration. It’s evident in people receiving and needing care, the hospitals and doctors providing care, and the taxpayers paying for care. We are all frustrated and lack confidence in our egotisical, greedy politicians who bicker like children while our country falters.
I hope the frustration will unite us--not divide us--and promote positive change. I'm sure no one intended to offend you.0 -
to keep this goingalice124 said:Health Reform
Don’t believe anyone disagrees with the necessity of health care reform. And I think this thread—while spouting many different opinions—reflects that need with a common denominator of frustration, growing frustration. It’s evident in people receiving and needing care, the hospitals and doctors providing care, and the taxpayers paying for care. We are all frustrated and lack confidence in our egotisical, greedy politicians who bicker like children while our country falters.
I hope the frustration will unite us--not divide us--and promote positive change. I'm sure no one intended to offend you.
Thought I would mention that I was told that they would get back to me in a couple days. Haven't heard anything yet. Alice, thanks for the info you had given me. Sort of my Ace in the hole.0
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